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COLONIAL MANOR I LLC
NPI 1013720283
Assisted Living Facility - Assisted Living, Mental Illness in Shelbyville, KY

Active since January 30, 2025CLIA 18D0963343 · Waiver
920 HENRY CLAY ST, SHELBYVILLE, KY 40065(516) 708-3503 Get Directions Write a Review

NPPES record last updated: January 30, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Colonial Manor I Llc NPPES

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

COLONIAL MANOR I LLC (NPI 1013720283) is a healthcare organization registered as an assisted living, mental illness in Shelbyville, Kentucky and active in the NPI registry since January 2025. The organization holds a CLIA Waiver certificate valid through July 26, 2027 and lists Raquel Edery, Coo, as its authorized official.

NPPES Registry Identity

NPI1013720283
Entity TypeOrganization
Primary Taxonomy3104A0625X
Legal Business NameCOLONIAL MANOR I LLC
Location Address920 HENRY CLAY STShelbyville, KY 40065-1333
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 1013720283 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.
920 HENRY CLAY ST, Shelbyville, KY 40065
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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 18D0963343

Colonial Manor I LLC · Shelbyville, KY
Active · expires Jul 26, 2027
CLIA Number18D0963343
Laboratory TypePersonal Care Home
Certificate Effective DateJuly 27, 2025
Certificate Expiration DateJuly 26, 2027
Laboratory DirectorMs. Breana Dugle
Laboratory Phone(917) 558-7558
Laboratory LocationColonial Manor I LLC920 Henry Clay St, Shelbyville, KY 40065
CLIA data matches this NPI record on: Address 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 Colonial Manor I LLC's NPI number?

The NPI number for Colonial Manor I LLC is 1013720283. It was assigned to this organization in the NPPES registry on January 30, 2025.

Where is Colonial Manor I LLC located?

Colonial Manor I LLC is located at 920 Henry Clay St, Shelbyville, KY 40065. The listed phone number is (516) 708-3503.

What is Colonial 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 Colonial Manor I LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D0963343) is associated with this NPI, valid through July 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Colonial 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.