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HENDERSON MANOR
NPI 1306659578
Assisted Living Facility - Assisted Living, Mental Illness in Henderson, KY

Active since January 30, 2025CLIA 18D0890483 · Waiver
201 WATSON LN, HENDERSON, KY 42420(516) 708-3503 Get Directions Write a Review

NPPES record last updated: January 30, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Henderson Manor NPPES

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

HENDERSON MANOR (NPI 1306659578) is a healthcare organization registered as an assisted living, mental illness in Henderson, Kentucky and active in the NPI registry since January 2025. The organization holds a CLIA Waiver certificate valid through August 18, 2028 and lists Raquel Edery, Coo, as its authorized official.

NPPES Registry Identity

NPI1306659578
Entity TypeOrganization
Primary Taxonomy3104A0625X
Legal Business NameHENDERSON MANOR
Location Address201 WATSON LNHenderson, KY 42420-2061
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 1306659578 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.
201 WATSON LN, Henderson, KY 42420
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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 18D0890483

Henderson Manor I LLC · Henderson, KY
Active · expires Aug 18, 2028
CLIA Number18D0890483
Laboratory TypePersonal Care Home
Certificate Effective DateAugust 19, 2026
Certificate Expiration DateAugust 18, 2028
Laboratory DirectorMs. Kenasha Melton
Laboratory Phone(917) 558-7558
Laboratory LocationHenderson Manor I LLC201 Watson Lane, Henderson, KY 42420
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 Henderson Manor's NPI number?

The NPI number for Henderson Manor is 1306659578. It was assigned to this organization in the NPPES registry on January 30, 2025.

Where is Henderson Manor located?

Henderson Manor is located at 201 Watson Ln, Henderson, KY 42420. The listed phone number is (516) 708-3503.

What is Henderson Manor's specialty?

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

Does Henderson Manor hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D0890483) is associated with this NPI, valid through August 18, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Henderson Manor 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 21 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.