MEDICARE: CAMELOT CARE CENTERS, 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

General Provider Information

NPI Number	:	1356541460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMELOT CARE CENTERS, INC

Provider Business Mailing Address
First Line	:	391 BROAD ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5039
Country	:	US
Telephone Number	:	423-476-3799
Fax Number	:	423-476-3795

Provider Business Practice Location Address
First Line	:	391 BROAD ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5039
Country	:	US
Telephone Number	:	423-476-3799
Fax Number	:	423-476-3795

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. LEIGH ANN VEALE
Credential	:	LMFT
Telephone Number	:	615-370-4228

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	06/26/2008

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