PARKSIDE MANOR I LLC
NPI 1003629262
Assisted Living Facility - Assisted Living, Mental Illness in Cynthiana, KY

Q: What is Parkside Manor I LLC's NPI number?

The NPI number for Parkside Manor I LLC is 1003629262. It was assigned to this organization in the NPPES registry on January 30, 2025.

Q: What is Parkside Manor I LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

Active since January 30, 2025CLIA 18D1060094 · Waiver

317 ODDVILLE AVE STE B, CYNTHIANA, KY 41031(516) 708-3503 Get Directions Write a Review

NPPES record last updated: January 30, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Parkside Manor I Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARKSIDE MANOR I LLC (NPI 1003629262) is a healthcare organization registered as an assisted living, mental illness in Cynthiana, Kentucky and active in the NPI registry since January 2025. The organization holds a CLIA Waiver certificate valid through October 15, 2026 and lists Raquel Edery, Coo, as its authorized official.

NPPES Registry Identity

NPI1003629262

Entity TypeOrganization

Primary Taxonomy3104A0625X

Legal Business NamePARKSIDE MANOR I LLC

Location Address317 ODDVILLE AVE STE BCynthiana, KY 41031-1142

Mailing Address455 Central Ave Ste 215Cedarhurst, NY 11516-2008 · (516) 708-3503

Phone(516) 708-3503

Organization SubpartNo

Authorized OfficialRaquel EderyCoo · (516) 708-3503

Enumeration DateJanuary 30, 2025

NPPES CertifiedJanuary 30, 2025

✔ NPI 1003629262 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living Facility · Assisted Living, Mental IllnessNursing & Custodial Care Facilities

Taxonomy Code3104A0625X

Definition

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.

317 ODDVILLE AVE STE B, Cynthiana, KY 41031

Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D1060094

Parkside Manor I LLC · Cynthiana, KY

Active · expires Oct 15, 2026

CLIA Number18D1060094

Laboratory TypePersonal Care Home

Certificate Effective DateOctober 16, 2024

Certificate Expiration DateOctober 15, 2026

Laboratory DirectorMs. Kim Perez

Laboratory Phone(917) 558-7558

Laboratory LocationParkside Manor I LLC317 Oddville Ave B, Cynthiana, KY 41031

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Parkside Manor I LLC's NPI number?

The NPI number for Parkside Manor I LLC is 1003629262. It was assigned to this organization in the NPPES registry on January 30, 2025.

Where is Parkside Manor I LLC located?

Parkside Manor I LLC is located at 317 Oddville Ave Ste B, Cynthiana, KY 41031. The listed phone number is (516) 708-3503.

What is Parkside Manor I LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

Does Parkside Manor I LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D1060094) is associated with this NPI, valid through October 15, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Parkside Manor I LLC was last updated on January 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.