NPIMap

Organization Active NPI

Camelot Community Care, Inc

  • Community/Behavioral Health Agency
  • Port St Lucie, FL
National Provider Identifier
1306512397
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CAMELOT COMMUNITY CARE, INC
Practice address
1801 SE Hillmoor Dr
Port St Lucie, FL 34952-7553
Phone
(561) 649-0877
NPI assigned
Aug 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Authorized official

Name
Jana Allen
Title
Director of Ar
Phone
(727) 593-0003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1801 SE Hillmoor Dr
Port St Lucie, FL 34952-7553

Mailing address

4910 Creekside Dr Ste D
Clearwater, FL 33760-4034
Phone (727) 593-0003

Other identifiers 1

IdentifierTypeStateIssuer
070592602MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Camelot Community Care Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1306512397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 CREEKSIDE DR STE D",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337604034",
            "telephone_number": "727-593-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 SE HILLMOOR DR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527553",
            "telephone_number": "561-649-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT COMMUNITY CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF AR",
        "authorized_official_telephone_number": "727-593-0003"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070592602",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.