NPIMap

Organization Active NPI

Camelot Realty, LLC

  • Intellectual Disabilities Intermediate Care Facility
  • Middletown, OH
National Provider Identifier
1639529100
Registry record updated Jun 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
CAMELOT REALTY, LLC
Practice address
4623 Central Avenue
Middletown, OH 45042
Phone
(513) 858-4550
NPI assigned
Jun 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2016

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

Authorized official

Name
Mary A Pank
Title
Paralegal
Phone
(502) 420-2666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

4623 Central Avenue
Middletown, OH 45042

Mailing address

9901 Linn Station Rd
Louisville, KY 40223-3808
Phone (502) 394-2100

Other names 1

  • Central Avenue Home Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G724

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CENTRAL AVENUE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 13, 2017
Last certification
Mar 27, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
4623 Central Avenue
Middletown, OH 45042

National Provider Directory

National Provider Directory
Tax ID family
Camelot Realty LLC4 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": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1639529100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9901 LINN STATION RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402233808",
            "telephone_number": "502-394-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4623 CENTRAL AVENUE",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "45042",
            "telephone_number": "513-858-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT REALTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "PANK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARALEGAL",
        "authorized_official_telephone_number": "502-420-2666"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Avenue Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Middletown, OH

Sources for this page

Verify at the official NPI Registry.