NPIMap

Organization Active NPI

Camelot Senior Living, Inc.

  • Custodial Care Facility
  • Sacramento, CA
National Provider Identifier
1427268408
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Custodial Care FacilityTaxonomy code 311Z00000X
Legal business name
CAMELOT SENIOR LIVING, INC.
Doing business as
Camelot Care Home 4
Practice address
974 Park Ranch Way
Sacramento, CA 95831-3064
Phone
(916) 803-1955
Fax
(916) 685-6343
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Scott Emerson Dahlquist
Title
President
Phone
(916) 803-1955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X CA Primary

Addresses

Primary practice location

974 Park Ranch Way
Sacramento, CA 95831-3064

Mailing address

8716 Milo CT
Elk Grove, CA 95624-1817
Phone (916) 803-1955

Other identifiers 1

IdentifierTypeStateIssuer
RCF00028FMedicaidCA

Other names 1

  • Camelot Care Home 4 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Camelot Care Home 14 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427268408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8716 MILO CT",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956241817",
            "telephone_number": "916-803-1955",
            "fax_number": "916-685-6343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "974 PARK RANCH WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958313064",
            "telephone_number": "916-803-1955",
            "fax_number": "916-685-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT SENIOR LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAHLQUIST",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "EMERSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-803-1955",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RCF00028F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camelot Care Home 4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.