Healthcare Provider Details

I. General information

NPI: 1700230976
Provider Name (Legal Business Name): CAMELOT CARE CENTERS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34121 NORTH ROUTE 45 SUITE 207
GRAYSLAKE IL
60030
US

IV. Provider business mailing address

333 W PIERCE RD STE 175
ITASCA IL
60143-3120
US

V. Phone/Fax

Practice location:
  • Phone: 847-993-9894
  • Fax: 847-543-4534
Mailing address:
  • Phone: 847-993-9894
  • Fax: 847-543-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RONICA PATEL
Title or Position: STATE EXECUTIVE DIRECTOR
Credential:
Phone: 630-773-1988