Lewisport Rest Home I LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

LEWISPORT REST HOME I LLC

Practice address

1580 4TH St
Lewisport, KY 42351-2529

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

Locations

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": "1871306035",
    "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": "1580 4TH ST",
            "city": "LEWISPORT",
            "state": "KY",
            "postal_code": "423512529",
            "telephone_number": "516-708-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWISPORT REST HOME 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": []
}

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• Lewisport Drugs Inc
• Lynch DME LLC (United Home Healthcare)
• George Marshall, LCSW
• McKena Tichenor, LLC
• Lelah Ann Monar
• Monica Montgomery I

• Assisted Living Facility (Mental Illness) in Lewisport, KY
• Providers in Lewisport, 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.