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PETTIS COUNTY ASSISTED LIVING, L.L.C.
NPI 1568821965
Assisted Living Facility in Sedalia, MO

Active since February 15, 2016CLIA 26D2118302 · Waiver
3017 BROOKING PARK AVE, SEDALIA, MO 65301(660) 827-3222(660) 829-2217 Get Directions Write a Review

NPPES record last updated: February 15, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pettis County Assisted Living, L.l.c. NPPES

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

PETTIS COUNTY ASSISTED LIVING, L.L.C. (NPI 1568821965) is a healthcare organization registered as an assisted living facility in Sedalia, Missouri and active in the NPI registry since February 2016. The organization holds a CLIA Waiver certificate valid through September 5, 2026 and lists Richard J Destefane, President, as its authorized official.

NPPES Registry Identity

NPI1568821965
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NamePETTIS COUNTY ASSISTED LIVING, L.L.C.
Location Address3017 BROOKING PARK AVESedalia, MO 65301-9327
Mailing Address1869 Craig Park CtSaint Louis, MO 63146-4122 · (314) 543-3800 · Fax (314) 543-3880
Phone(660) 827-3222
Fax(660) 829-2217
Organization SubpartNo
Authorized OfficialRichard J DestefanePresident · (314) 543-3800
Enumeration DateFebruary 15, 2016
✔ NPI 1568821965 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Also ListedAssisted Living Facility · Assisted Living, Mental IllnessTaxonomy 3104A0625X
3017 BROOKING PARK AVE, Sedalia, MO 65301
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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 26D2118302

Pettis Coiunty Assisted Living · Sedalia, MO
Active · expires Sep 5, 2026
CLIA Number26D2118302
Laboratory TypeAssisted Living Facility
Certificate Effective DateSeptember 6, 2024
Certificate Expiration DateSeptember 5, 2026
Laboratory DirectorPares Chapel
Laboratory Phone(314) 543-3816
Laboratory LocationPettis Coiunty Assisted Living3017 Brooking Park Avenue, Sedalia, MO 65301
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

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 Pettis County Assisted Living, L.L.C.'s NPI number?

The NPI number for Pettis County Assisted Living, L.L.C. is 1568821965. It was assigned to this organization in the NPPES registry on February 15, 2016.

Where is Pettis County Assisted Living, L.L.C. located?

Pettis County Assisted Living, L.L.C. is located at 3017 Brooking Park Ave, Sedalia, MO 65301. The listed phone number is (660) 827-3222.

What is Pettis County Assisted Living, L.L.C.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Pettis County Assisted Living, L.L.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2118302) is associated with this NPI, valid through September 5, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pettis County Assisted Living, L.L.C. was last updated on February 15, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years 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.