NPIMap

Organization Active NPI

Camelot Care Centers, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Matteson, IL
National Provider Identifier
1710217336
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
CAMELOT CARE CENTERS, LLC
Practice address
4747 Lincoln Mall Dr Ste 305
Matteson, IL 60443-3814
Phone
(708) 747-7250
Fax
(708) 647-7258
NPI assigned
Jan 4, 2010
Last updated
Jun 4, 2020By 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 Jun 4, 2020

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

Authorized official

Name
Ronica R Patel
Title
State Executive Director
Phone
(630) 773-1985

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

4747 Lincoln Mall Dr Ste 305
Matteson, IL 60443-3814

Mailing address

333 W Pierce Rd Ste 175
Itasca, IL 60143-3120
Phone (708) 747-7250

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": "1262563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1710217336",
    "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": "708-747-7250",
            "fax_number": "708-647-7258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 LINCOLN MALL DR STE 305",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433814",
            "telephone_number": "708-747-7250",
            "fax_number": "708-647-7258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT CARE CENTERS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC.",
        "enumeration_date": "2010-01-04",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RONICA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "STATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-773-1985"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2B05-IPI-141",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Matteson, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.