Provider Demographics
NPI:1780550376
Name:SPRINGFIELD SNF OPCO LLC
Entity type:Organization
Organization Name:SPRINGFIELD SNF OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTEFANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-3800
Mailing Address - Street 1:1869 CRAIG PARK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:314-226-1736
Practice Address - Street 1:404 E MCCREIGHT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-3653
Practice Address - Country:US
Practice Address - Phone:937-399-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility