GLENDALE ASSISTED LIVING NPI 1194864447

NPI Information

  • NPI: 1194864447
  • Provider Name: GLENDALE ASSISTED LIVING
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: FREDERICK ST MANOR MAPLE CREST MANOR
  • CLIA Number: 26D0969650
  • Address: 430 N FREDERICK
    CAPE GIRARDEAU, MO
    ZIP 63701
  • Phone: (573) 334-2662

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NPI Details

GLENDALE ASSISTED LIVING is an 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 assistance and/or monitoring to assure safety and well being. GLENDALE ASSISTED LIVING NPI is 1194864447. The provider is registered as an organization entity type.
The provider Is Doing Business As Frederick St Manor Maple Crest Manor.

The provider's business location address is:

430 N FREDERICK
CAPE GIRARDEAU, MO
ZIP 63701
Phone: (573) 334-2662
Fax: (573) 339-7541

The provider's authorized official is Teresa A Compton .
The authorized official title is Administrator and has the following contact phone number (573) 334-2662.

The CLIA number assigned to this NPI record is 26D0969650 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/5/2007 and was last updated on 8/22/2020.

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 FacilityYes

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

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