COLONIAL MANOR I LLC
NPI 1013720283
Assisted Living Facility - Assisted Living, Mental Illness in Shelbyville, KY
NPI Status: Active since January 30, 2025
Contact Information
920 HENRY CLAY ST
SHELBYVILLE, KY
ZIP 40065
Phone: (516) 708-3503
- Organization
- Assisted Living Facility
- Assisted Living, Mental Illness
- CLIA Number: 18D0963343
- CLIA Cert. Type: Other - PERSONAL CARE HOME
- CLIA Exp. Date: 07-26-2027
About COLONIAL MANOR I LLC
This page provides the complete NPI Profile along with additional information for Colonial Manor I Llc, a provider established in Shelbyville, Kentucky operating as a Assisted Living Facility, focusing in assisted living, mental illness . The healthcare provider is registered in the NPI registry with number 1013720283 assigned on January 2025. The practitioner's primary taxonomy code is 3104A0625X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Raquel Edery (Coo)
- NPI
- 1013720283
- Provider Name
- COLONIAL MANOR I LLC
- Entity Type
- Organization
- Location Address
- 920 HENRY CLAY ST SHELBYVILLE, KY 40065
- Location Phone
- (516) 708-3503
- Mailing Address
- 455 CENTRAL AVE STE 215 CEDARHURST, NY 11516
- Mailing Phone
- (516) 708-3503
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-30-2025
- Last Update Date
- 01-30-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility Assisted Living, Mental Illness
- Taxonomy Code
- 3104A0625X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- 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.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 18D0963343
- Facility Type
- Other - PERSONAL CARE HOME
- Certificate Effective Date
- July 27, 2025
- Certificate Expiration Date
- July 26, 2027
- Laboratory Director
- MS. BREANA DUGLE
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Colonial Manor I Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1013720283, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 47. The final step is to find the difference between that total and the next multiple of ten (50 - 47 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 47 is 50. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1013720283, enumerated as an "organization" on January 30, 2025.
The provider is located at 920 HENRY CLAY ST SHELBYVILLE, KY 40065 and the phone number is (516) 708-3503.
Assisted Living Facility with taxonomy code 3104A0625X and a focus in Assisted Living, Mental Illness.
