Frederick Street Manor LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

FREDERICK STREET MANOR LLC

Doing business as

Frederick Street Manor

Practice address

429 N Frederick St
Cape Girardeau, MO 63701-4834

Phone

(573) 334-0916

NPI assigned

Jun 17, 2021

Organization subpart

No

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

Authorized official

Name

Kevin Wood

Title

Owner

Phone

(573) 576-3029

Specialties & licenses 2

Addresses

Other names 1

• Frederick Street Manor Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623888000000",
    "number": "1518535285",
    "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": "429 N FREDERICK ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014834",
            "telephone_number": "573-334-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK STREET MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "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": "Frederick Street Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Ann Frank, LMSW
• Matthew Frank, M.D.
• Natelie Rachelle Frazier-Cook, APRN, FNP-BC
• Regina Marie Frazier, FNP-C
• Julie Marie Fredenburg, MA, CCC-SLP
• Michael R Freeman, M.D.
• John Michael Freeze, D.D.S.
• Laura D. French, OT
• Audrey Rachel Frenz, DMD
• Tina Fuller, LPN

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.