NPIMap

Organization Active NPI

Camelot Healthcare, LLC

Doing business as Camelot Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Farmington, MO
National Provider Identifier
1043889678
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CAMELOT HEALTHCARE, LLC
Doing business as
Camelot Nursing and Rehabilitation Center
Practice address
705 Grand Canyon Dr
Farmington, MO 63640-2161
Phone
(573) 756-8911
NPI assigned
Jun 18, 2021
Last updated
Jun 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judah Bienstock
Title
Ceo
Phone
(314) 631-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

705 Grand Canyon Dr
Farmington, MO 63640-2161

Mailing address

477 N Lindbergh Blvd Ste 310
Saint Louis, MO 63141-7856
Phone (314) 631-3000

Other names 1

  • Camelot Nursing and Rehabilitation Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211026001676 MO Part A Provider - Skilled Nursing Facility 8224426101 Practice locations: Farmington, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043889678. Details of each certification follow.

Skilled nursing facility certification: CCN 265348

Legal name
CAMELOT HEALTHCARE, LLC
Doing business as
CAMELOT NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1989
Last certification
Oct 25, 2024
Beds
97
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
May 28, 2021 in MO
Enrollment address
705 Grand Canyon Dr
Farmington, MO 63640-2161
Nursing home name
CAMELOT NURSING AND REHABILITATION CENTER
Affiliated entity
MGM HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Camelot Nursing and Rehabilitation CenterCCN 265348 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9770.4 residents per day on average
Chain
MGM Healthcare27 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0441774Camelot Healthcare, LLC705 Grand Canyon Dr, Farmington, MO 63640Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Networks

  • devoted network organization-4d06b5ed-aefa-4033-b81c-2adf126fd114

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Baruch Jeremias Individual 5% Or Greater Indirect Ownership Interest Oct 18, 2021 100%
Camelot SNF Investments, LLC Organization, Saint Louis, MO Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Oct 18, 2021 50%
10-26 Nationwide TR Organization, Lakewood, NJ 5% Or Greater Indirect Ownership Interest Oct 18, 2021 50%
Krista R Cissell Individual W-2 Managing Employee Oct 18, 2021 100%
Judah Bienstock Individual 5% Or Greater Indirect Ownership Interest Oct 18, 2021 100%
Corporate Officer Oct 18, 2021

Facilities with the same owner 39

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 39

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623974400000",
    "number": "1043889678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 N LINDBERGH BLVD STE 310",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417856",
            "telephone_number": "314-631-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 GRAND CANYON DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636402161",
            "telephone_number": "573-756-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-18",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A",
        "authorized_official_last_name": "BIENSTOCK",
        "authorized_official_first_name": "JUDAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-631-3000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camelot Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.