The Camelot Society

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

THE CAMELOT SOCIETY

Doing business as

Chelsea Group Home

Practice address

26511 NE Virginia St
Duvall, WA 98019-8461

Phone

(425) 481-5853

Fax

(425) 481-5763

NPI assigned

May 17, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Autumn L. Calkins

Title

Executive Director

Phone

(425) 481-5853

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Chelsea Group Home Doing business as

Tax ID family

Camelot Society6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

• The Camelot Society

  dba Camelot Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Seattle, WA
  • NPI 1518174564
  NPD tax ID
• The Camelot Society

  dba Carlton Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Duvall, WA
  • NPI 1538377064
  NPD tax ID
• The Camelot Society

  dba Camelot Society

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Woodinville, WA
  • NPI 1629286158
  NPD tax ID
• The Camelot Society

  dba Camelot Society

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mountlake Terrace, WA
  • NPI 1811104763
  NPD tax ID
• The Camelot Society

  dba Camelot Society

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mountlake Terrace, WA
  • NPI 1851508717
  NPD tax ID

Locations

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790992683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18606 BOTHELL WAY NE",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980111929",
            "telephone_number": "425-481-5853",
            "fax_number": "425-481-5763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26511 NE VIRGINIA ST",
            "city": "DUVALL",
            "state": "WA",
            "postal_code": "980198461",
            "telephone_number": "425-481-5853",
            "fax_number": "425-481-5763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CAMELOT SOCIETY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CALKINS",
        "authorized_official_first_name": "AUTUMN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "425-481-5853"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICFMR GROUP HOME",
            "identifier": "4966909",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chelsea Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Catherine Elisabeth Stolp, LM, MSC
• Vidya M Subramanian
• Thushyanthi Suntharalingam, D.D.S.
• Elbetel Tamru
• The Camelot Society (Carlton Group Home)
• Chantel Thurman, LMHCA
• Thushyanthi Suntharalingam DDS PLLC
• Marykathleen Schurman Tihinen
• Austin Tinguely
• Rachel Tinsley, LMT

• Intellectual Disabilities Intermediate Care Facility in Duvall, WA
• Providers in Duvall, WA by specialty
• Intellectual Disabilities Intermediate Care Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.