Healthcare Provider Details

I. General information

NPI: 1740888205
Provider Name (Legal Business Name): CAMELOT CARE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 GOVERNORS DR STE 301
OLYMPIA FIELDS IL
60461-3003
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 708-747-7250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONICA R PATEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 630-773-1985