Shady Lawn I LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

SHADY LAWN I LLC

Practice address

108 S Miller St
Cynthiana, KY 41031-1601

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

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": "1922811181",
    "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": "108 S MILLER ST",
            "city": "CYNTHIANA",
            "state": "KY",
            "postal_code": "410311601",
            "telephone_number": "516-708-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY LAWN 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": []
}

• Brian Rooney, PTA
• Neil C Rush, D.M.D.
• Cherity Sayre, RN
• Campbell Karl Schulstad, MD
• Leslie Ellen Schwindel, M.D.
• Shepherd Surgical Assisting
• Heather Y Shepherd, SAC
• Rachel Clare Shercliffe, MD
• Jeremy Vanloring Smith, O.D.
• Sorrell Home Medical Equipment, LLC

• 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.