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General NPI Number Information
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NPI Number | 1609689868
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Entity Type | Organization
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Legal Business Name | MADISONVILLE REST HOME I LLC
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 140 GIVENS ST
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City | MADISONVILLE
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State | KY
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Zip | 42431-1619
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Country | US
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Telephone | 165-708-3503
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Fax |
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Provider Business Mailing Address
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Address Line | 455 CENTRAL AVE STE 215
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City | CEDARHURST
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State | NY
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Zip | 11516-2008
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Country | US
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Telephone | 516-708-3503
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Fax |
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Authorized Official
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Title or Position | COO
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Name | RAQUEL EDERY
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Credential |
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Telephone | 516-708-3503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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