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General NPI Number Information
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NPI Number | 1538767090
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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 | 10/15/2020
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 2501 CHATHAM RD STE 220
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7128
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Country | US
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Telephone | 217-525-9185
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Fax |
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Provider Business Mailing Address
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Address Line | 333 W PIERCE RD STE 175
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City | ITASCA
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State | IL
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Zip | 60143-3120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RONICA R 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 | 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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