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General NPI Number Information
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NPI Number | 1023349081
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Entity Type | Organization
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Legal Business Name | CAMELOT CARE CENTERS, LLC.
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 5301 E STATE ST SUITE 208
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City | ROCKFORD
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State | IL
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Zip | 61108-2901
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Country | US
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Telephone | 815-484-9180
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Fax | 815-484-9183
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Provider Business Mailing Address
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Address Line | 5301 E STATE ST SUITE 208
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City | ROCKFORD
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State | IL
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Zip | 61108-2901
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Country | US
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Telephone | 815-484-9180
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Fax | 815-484-9183
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Authorized Official
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Title or Position | STATE EXECUTIVE DIRECTOR
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Name | RONICA PATEL
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Credential |
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Telephone | 630-773-1985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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