FREDERICK STREET MANOR LLC
NPI 1518535285
Assisted Living Facility - Assisted Living, Mental Illness in Cape Girardeau, MO
About Frederick Street Manor Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FREDERICK STREET MANOR LLC (NPI 1518535285), doing business as Frederick Street Manor, is a healthcare organization registered as an assisted living, mental illness in Cape Girardeau, Missouri and active in the NPI registry since June 2021. The organization holds a CLIA Waiver certificate valid through January 20, 2028 and lists Kevin Wood, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
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 26D0969650
Frederick Street Manor · Cape Girardeau, MOOther Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Frederick Street Manor LLC's NPI number?
The NPI number for Frederick Street Manor LLC is 1518535285. It was assigned to this organization in the NPPES registry on June 17, 2021. The provider is doing business as Frederick Street Manor.
Where is Frederick Street Manor LLC located?
Frederick Street Manor LLC is located at 429 N Frederick St, Cape Girardeau, MO 63701. The listed phone number is (573) 334-0916.
What is Frederick Street Manor LLC's specialty?
The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.
Does Frederick Street Manor LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 26D0969650) is associated with this NPI, valid through January 20, 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 Frederick Street Manor LLC was last updated on June 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Frederick Street Manor Llc · NPI 1518535285
Assisted Living, Mental Illness organization in Cape Girardeau, Missouri. Organization record, active in the CMS NPPES registry since June 17, 2021.
## Identity
- **NPI:** 1518535285 (Entity type: Organization)
- **Enumerated:** June 17, 2021
- **Primary specialty:** Assisted Living Facility - Assisted Living, Mental Illness · taxonomy 3104A0625X
- **Also known as:** Frederick Street Manor (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Kevin Wood, OWNER
## Practice location
- **Address:** 429 N FREDERICK ST, Cape Girardeau, MO 63701-4834
- **Phone:** (573) 334-0916
## Record status
- **NPPES last updated:** June 17, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1518535285) · Data from the CMS NPPES public registry.