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NPI Code Detail

MEDICARE: CAMELOT COMMUNITY CARE, INC

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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

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

General Provider Information

NPI Number : 1346918380
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 :
Provider Business Practice Location Address
First Line : 1925 S PERIMETER RD STE 120
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-7123
Country : US
Telephone Number : 954-958-0988
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF AR
Name : JANA ALLEN
Credential :
Telephone Number : 727-593-0003
Provider Enumeration Date : 09/03/2021
Last Update Date : 09/03/2021

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Directions to “CAMELOT COMMUNITY CARE, INC ” Practice Location

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