NPIMap

Organization Active NPI

Camelot Care Centers, Inc

  • Community/Behavioral Health Agency
  • Peoria, IL
National Provider Identifier
1780913756
Registry record updated Dec 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CAMELOT CARE CENTERS, INC
Practice address
5901 N Prospect Rd Ste 101
Peoria, IL 61614-4395
Phone
(309) 692-1095
Fax
(309) 692-1375
NPI assigned
Dec 21, 2009
Organization subpart
Yes
Parent organization
CAMELOT CARE CENTERS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2009

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

Authorized official

Name
Mr. Jason Keeler
Title
State Director
Phone
(630) 773-1985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

5901 N Prospect Rd Ste 101
Peoria, IL 61614-4395

Mailing address

5901 N Prospect Rd Ste 101
Peoria, IL 61614-4395
Phone (309) 692-1095

Other identifiers 1

IdentifierTypeStateIssuer
2B05-IPI-141MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Camelot Care Centers in20 organizations share this tax ID, including this one
Part of
Camelot Care Centers in

Other organizations with this tax ID 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261353600000",
    "number": "1780913756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 N PROSPECT RD STE 101",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144395",
            "telephone_number": "309-692-1095",
            "fax_number": "309-692-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N PROSPECT RD STE 101",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144395",
            "telephone_number": "309-692-1095",
            "fax_number": "309-692-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT CARE CENTERS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAMELOT CARE CENTERS, INC",
        "enumeration_date": "2009-12-21",
        "last_updated": "2009-12-21",
        "status": "A",
        "authorized_official_last_name": "KEELER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "STATE DIRECTOR",
        "authorized_official_telephone_number": "630-773-1985",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2B05-IPI-141",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; 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.