NORTH VILLAGE PARK SNF OPCO LLC
NPI 1295661700
Skilled Nursing Facility in Moberly, MO

Active since June 22, 2026CLIA 26D0446609 · Waiver
2041 SILVA LN, MOBERLY, MO 65270(660) 269-7300(660) 263-0751 Get Directions Write a Review

NPPES record last updated: June 22, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About North Village Park Snf Opco Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTH VILLAGE PARK SNF OPCO LLC (NPI 1295661700), doing business as North Village Park, is a healthcare organization registered as a skilled nursing facility in Moberly, Missouri and active in the NPI registry since June 2026. The organization holds a CLIA Waiver certificate valid through August 31, 2028 and lists Nicholas Destefane, President, as its authorized official.

NPPES Registry Identity

NPI1295661700
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameNORTH VILLAGE PARK SNF OPCO LLC
Location Address2041 SILVA LNMoberly, MO 65270-3658
Mailing Address1869 Craig Park CtSaint Louis, MO 63146-4122 · (314) 543-3800 · Fax (314) 543-3800
Fax(660) 263-0751
Organization SubpartNo
Authorized OfficialNicholas DestefanePresident · (314) 543-3800
Enumeration DateJune 22, 2026
NPPES CertifiedJune 22, 2026
✔ NPI 1295661700 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
2041 SILVA LN, Moberly, MO 65270

Other Names 1

Doing Business AsNorth Village Park

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D0446609

North Village Park · Moberly, MO
Active · expires Aug 31, 2028
CLIA Number26D0446609
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2026
Certificate Expiration DateAugust 31, 2028
Laboratory DirectorKayla Pruitt
Laboratory Phone(660) 269-7300
Laboratory LocationNorth Village Park2041 Silva Lane, Moberly, MO 65270
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
2041 SILVA LN
MOBERLY, MO 65270

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is North Village Park Snf Opco LLC's NPI number?

The NPI number for North Village Park Snf Opco LLC is 1295661700. It was assigned to this organization in the NPPES registry on June 22, 2026. The provider is doing business as North Village Park.

Where is North Village Park Snf Opco LLC located?

North Village Park Snf Opco LLC is located at 2041 Silva Ln, Moberly, MO 65270. The listed phone number is (660) 269-7300.

What is North Village Park Snf Opco LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does North Village Park Snf Opco LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0446609) is associated with this NPI, valid through August 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for North Village Park Snf Opco LLC was last updated on June 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.