NPIMap

Organization Active NPI

Camelot of Virginia, LLC

Doing business as Wytheville Goup Home

  • Mental Illness Community Based Residential Treatment Facility
  • Wytheville, VA
National Provider Identifier
1467648972
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
Wytheville Goup Home
Practice address
290 E Monroe St
Wytheville, VA 24382-2336
Phone
(276) 228-7100
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 NU Primary

Addresses

Primary practice location

290 E Monroe St
Wytheville, VA 24382-2336

Mailing address

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

Other names 1

  • Wytheville Goup 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.

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": "1467648972",
    "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": "290 E MONROE ST",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243822336",
            "telephone_number": "276-228-7100"
        }
    ],
    "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wytheville Goup Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wytheville, 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.