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COLONIAL HOUSE I LLC
NPI 1104639376
Assisted Living Facility - Assisted Living, Mental Illness in Shepherdsville, KY

Active since January 30, 2025CLIA 18D0956970 · Waiver
1516 HIGHWAY 44 E, SHEPHERDSVILLE, KY 40165(502) 883-9113 Get Directions Write a Review

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

About Colonial House I Llc NPPES

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

COLONIAL HOUSE I LLC (NPI 1104639376) is a healthcare organization registered as an assisted living, mental illness in Shepherdsville, Kentucky and active in the NPI registry since January 2025. The organization holds a CLIA Waiver certificate valid through February 8, 2027 and lists Raquel Edery, Coo, as its authorized official.

NPPES Registry Identity

NPI1104639376
Entity TypeOrganization
Primary Taxonomy3104A0625X
Legal Business NameCOLONIAL HOUSE I LLC
Location Address1516 HIGHWAY 44 EShepherdsville, KY 40165-7182
Mailing Address455 Central Ave Ste 215Cedarhurst, NY 11516-2008 · (516) 708-3503
Phone(502) 883-9113
Organization SubpartNo
Authorized OfficialRaquel EderyCoo · (516) 708-3503
Enumeration DateJanuary 30, 2025
NPPES CertifiedJanuary 30, 2025
✔ NPI 1104639376 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.
1516 HIGHWAY 44 E, Shepherdsville, KY 40165
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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 18D0956970

Colonial House I LLC · Shepherdsville, KY
Active · expires Feb 8, 2027
CLIA Number18D0956970
Laboratory TypePersonal Care Home
Certificate Effective DateFebruary 9, 2025
Certificate Expiration DateFebruary 8, 2027
Laboratory DirectorMs. Amanda Pugh
Laboratory Phone(917) 558-7558
Laboratory LocationColonial House I LLC1516 Highway 44 E, Shepherdsville, KY 40165
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 House I LLC's NPI number?

The NPI number for Colonial House I LLC is 1104639376. It was assigned to this organization in the NPPES registry on January 30, 2025.

Where is Colonial House I LLC located?

Colonial House I LLC is located at 1516 Highway 44 E, Shepherdsville, KY 40165. The listed phone number is (502) 883-9113.

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

Yes. A Certificate of Waiver (number 18D0956970) is associated with this NPI, valid through February 8, 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 House 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.