NPIMap

Organization Active NPI

Camelot of Virginia, LLC

Doing business as Roanoke Group Home

  • Mental Illness Community Based Residential Treatment Facility
  • Roanoke, VA
National Provider Identifier
1083800593
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
CAMELOT OF VIRGINIA, LLC
Doing business as
Roanoke Group Home
Practice address
1729 Patterson Ave SW
Roanoke, VA 24016-3105
Phone
(540) 345-4533
NPI assigned
Sep 18, 2007
Last updated
Sep 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

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

Authorized official

Name
Grayson Harcourt
Title
Business Office Director
Phone
(512) 858-9900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

1729 Patterson Ave SW
Roanoke, VA 24016-3105

Mailing address

4207 E Highway 290
Dripping Springs, TX 78620-4206
Phone (512) 858-9900

Other names 1

  • Roanoke Group Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Camelot of Virginia LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1729 Patterson Ave SW
Roanoke, VA 24016
Phone (540) 345-4533

NPI Registry JSON

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1083800593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4207 E HIGHWAY 290",
            "city": "DRIPPING SPRINGS",
            "state": "TX",
            "postal_code": "786204206",
            "telephone_number": "512-858-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1729 PATTERSON AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240163105",
            "telephone_number": "540-345-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT OF VIRGINIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "HARCOURT",
        "authorized_official_first_name": "GRAYSON",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "512-858-9900"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roanoke Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.