NPIMap

Organization Active NPI

Camelot Care Centers, LLC.

  • Community/Behavioral Health Agency
  • Grayslake, IL
National Provider Identifier
1700230976
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CAMELOT CARE CENTERS, LLC.
Practice address
34121 North Route 45
Suite 207
Grayslake, IL 60030
Phone
(847) 993-9894
Fax
(847) 543-4534
NPI assigned
Apr 14, 2016
Last updated
Aug 26, 2019By 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 Aug 26, 2019

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

Authorized official

Name
Ronica Patel
Title
State Executive Director
Phone
(630) 773-1988

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foster Care Agency 253J00000X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

34121 North Route 45
Suite 207
Grayslake, IL 60030

Mailing address

333 W Pierce Rd Ste 175
Itasca, IL 60143-3120
Phone (847) 993-9894

Other identifiers 1

IdentifierTypeStateIssuer
2B05-IPI-141MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Camelot Care Services21 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

NPI Registry JSON

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1700230976",
    "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",
            "telephone_number": "847-993-9894",
            "fax_number": "847-543-4534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34121 NORTH ROUTE 45",
            "address_2": "SUITE 207",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "60030",
            "telephone_number": "847-993-9894",
            "fax_number": "847-543-4534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT CARE CENTERS, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC.",
        "enumeration_date": "2016-04-14",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RONICA",
        "authorized_official_title_or_position": "STATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-773-1988"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2B05-IPI-141",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.