MAPLE CREST MANOR LLC NPI 1184292039

NPI Information

  • NPI: 1184292039
  • Provider Name: MAPLE CREST MANOR LLC
  • Classification: Assisted Living Facility - 3104A0625X
  • Specialization: Assisted Living, Mental Illness
  • Entity Type: Organization
  • Doing Business As: MAPLE CREST MANOR
  • CLIA Number: 26D0969649
  • Address: 430 N FREDERICK ST
    CAPE GIRARDEAU, MO
    ZIP 63701
  • Phone: (573) 339-7606

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NPI Details

MAPLE CREST MANOR LLC is an assisted living and mental illness assisted living facility in Cape Girardeau, MO. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. MAPLE CREST MANOR LLC NPI is 1184292039. The provider is registered as an organization entity type.
The provider Is Doing Business As Maple Crest Manor.

The provider's business location address is:

430 N FREDERICK ST
CAPE GIRARDEAU, MO
ZIP 63701-835
Phone: (573) 339-7606

The provider's authorized official is Kevin Wood .
The authorized official title is Owner and has the following contact phone number (573) 576-3029.

The CLIA number assigned to this NPI record is 26D0969649 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/16/2021 and was last updated on 6/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityNo
23104A0625XAssisted Living FacilityAssisted Living, Mental IllnessYes

What is NPI?

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This page was last updated on: 11/21/2025

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