Organization Active NPI

Cornerstone Manor I LLC

  • Assisted Living Facility (Mental Illness)
  • Scottsville, KY
National Provider Identifier
1073326237
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
Legal business name
CORNERSTONE MANOR I LLC
Practice address
515 Water St
Scottsville, KY 42164-1167
Phone
(516) 708-3503
NPI assigned
Jan 30, 2025
Last updated
Jan 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X NU Primary

Addresses

Primary practice location

515 Water St
Scottsville, KY 42164-1167

Mailing address

455 Central Ave Ste 215
Cedarhurst, NY 11516-2008
Phone (516) 708-3503

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1041660Cornerstone Manor I LLC515 Water St, Scottsville, KY 42164Certificate of waiverFeb 15, 2028

National Provider Directory

National Provider Directory

Locations

515 Water St
Scottsville, KY 42164
Phone (270) 237-3485

NPI Registry JSON

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": "1073326237",
    "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": "515 WATER ST",
            "city": "SCOTTSVILLE",
            "state": "KY",
            "postal_code": "421641167",
            "telephone_number": "516-708-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE 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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsville, KY

Sources for this page

  • 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.