Healthcare Provider Details

I. General information

NPI: 1720073679
Provider Name (Legal Business Name): CAMELOT HEALTHCARE MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3381 US HIGHWAY 17-92 WEST
HAINES CITY FL
33844
US

IV. Provider business mailing address

3381 US HIGHWAY 17-92 WEST
HAINES CITY FL
33844
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-6533
  • Fax: 863-293-4722
Mailing address:
  • Phone: 863-293-6533
  • Fax: 863-293-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberHME909
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHME909
License Number StateFL

VIII. Authorized Official

Name: MR. ANGEL ARCIENO
Title or Position: PRESIDENT
Credential:
Phone: 305-632-5834