Colonial Manor I LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

COLONIAL MANOR I LLC

Practice address

920 Henry Clay St
Shelbyville, KY 40065-1333

Phone

(516) 708-3503

NPI assigned

Jan 30, 2025

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

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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": "1013720283",
    "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": "920 HENRY CLAY ST",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400651333",
            "telephone_number": "516-708-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL 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": []
}

• Lauralee C Coleman, PA-C
• Taryn Alyse Coleman, APRN
• Christopher Collett, PA
• Emily Deshae Collins, CF-SLP
• Maida E Colon, MD
• Lauren Ashley Comer
• Commonwealth Urology Shelbyville
• Community Vision Therapy Associates
• Comprehensive Foot & Ankle Centers
• Comprehensive Foot & Ankle Centers

• Assisted Living Facility (Mental Illness) in Shelbyville, KY
• Providers in Shelbyville, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.