Parkside Manor I LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

PARKSIDE MANOR I LLC

Practice address

317 Oddville Ave Ste B
Cynthiana, KY 41031-1142

Phone

(516) 708-3503

NPI assigned

Jan 30, 2025

Last updated

Jan 30, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raquel Edery

Title

Coo

Phone

(516) 708-3503

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1003629262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 CENTRAL AVE STE 215",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115162008",
            "telephone_number": "516-708-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 ODDVILLE AVE STE B",
            "city": "CYNTHIANA",
            "state": "KY",
            "postal_code": "410311142",
            "telephone_number": "516-708-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE MANOR I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "EDERY",
        "authorized_official_first_name": "RAQUEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "516-708-3503"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Vista of the Bluegrass Inc
• Richard Henry Norfleet, MD
• Janet Olson
• Anna L Otis, MSW, CSW
• Parke Physicians PLLC
• Parkside Manor LLC
• Jeremy Lee Penn, OD
• John Francis Peppin, D.O.
• James Pettey, MD
• John Pidakala, MD

• Assisted Living Facility (Mental Illness) in Cynthiana, KY
• Providers in Cynthiana, KY by specialty
• Assisted Living Facility (Mental Illness) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.