MEDICARE: CAMELOT COMMUNITY CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063771780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMELOT COMMUNITY CARE, INC

Provider Business Mailing Address
First Line	:	4910 CREEKSIDE DR STE D
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33760-4034
Country	:	US
Telephone Number	:	727-593-0003
Fax Number	:	727-595-0735

Provider Business Practice Location Address
First Line	:	7162 READING RD STE 300
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3899
Country	:	US
Telephone Number	:	513-961-5900
Fax Number	:	513-961-5903

Authorized Official
Title or Position	:	DIRECTOR OF AR
Name	:	JANA ALLEN
Credential	:
Telephone Number	:	727-593-0003

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	07/13/2021

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