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General NPI Number Information
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NPI Number | 1447812250
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Entity Type | Organization
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Legal Business Name | CAMELLIA PLACE HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 100 MARKET SQ STE 12
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City | NEWINGTON
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State | CT
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Zip | 06111-2921
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Country | US
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Telephone | 860-322-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 24 SACHEM CIR
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City | MERIDEN
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State | CT
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Zip | 06450-7403
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Country | US
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Telephone | 203-715-1319
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. CAMILLE A PAYNE
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Credential | MPH, APRN, DNP
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Telephone | 860-322-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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