NPIMap

Organization Active NPI

Camelot Care Centers, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Peoria, IL
National Provider Identifier
1215535786
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
CAMELOT CARE CENTERS, LLC
Practice address
817 W Pioneer Pkwy
Peoria, IL 61615-2144
Phone
(309) 676-6305
NPI assigned
Oct 15, 2020
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Ronica R Patel
Title
Executive Director
Phone
(630) 773-1985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

817 W Pioneer Pkwy
Peoria, IL 61615-2144

Mailing address

333 W Pierce Rd Ste 175
Itasca, IL 60143-3120

National Provider Directory

National Provider Directory
Tax ID family
Camelot Care Centers in21 organizations share this tax ID, including this one
Part of
Camelot Care Centers LLC

Other organizations with this tax ID 20

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

View all 20

Locations

817 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 676-6305

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1215535786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 W PIERCE RD STE 175",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601433120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 W PIONEER PKWY",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152144",
            "telephone_number": "309-676-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT CARE CENTERS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC.",
        "enumeration_date": "2020-10-15",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RONICA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-773-1985"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.