Organization
FREDERICK STREET MANOR LLC
Active
Other names
Frederick Street Manor
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN WOOD (OWNER)
(573) 576-3029
Entity
Organization
Contact information
Practice address
429 N FREDERICK ST, CAPE GIRARDEAU, MO 63701-4834
(573) 334-0916
Mailing address
PO BOX 1570, CAPE GIRARDEAU, MO 63702-1570
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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