Maple Crest Manor LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

MAPLE CREST MANOR LLC

Doing business as

Maple Crest Manor

Practice address

430 N Frederick St
Cape Girardeau, MO 63701-4835

Phone

(573) 339-7606

NPI assigned

Jun 16, 2021

Last updated

Jun 17, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin WoodNPI 1952607012

Title

Owner

Phone

(573) 576-3029

Specialties & licenses 2

Addresses

Other names 1

• Maple Crest Manor Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Wood, PHARMD

  • Pharmacist
  • Cape Girardeau, MO
  • NPI 1952607012
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623888000000",
    "number": "1184292039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1570",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637021570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 N FREDERICK ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014835",
            "telephone_number": "573-339-7606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE CREST MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-16",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-576-3029"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Crest Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Crest Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael D Malone, MD
• Tracie Manes, LPC
• Savannah Manetz
• Jacob Benjamin Manier, DO
• Subir Mann
• Laura Marble, MD
• Marion Eye Centers, LTD.
• Thomas W Marsh, M.D.
• Martin Ear Nose & Throat Clinic
• Amanda Dee Martin, ATC, LAT

• Assisted Living Facility (Mental Illness) in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Assisted Living Facility (Mental Illness) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.