Camelot Terrace, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0043877 Issued in IL

Legal business name

CAMELOT TERRACE, INC.

Practice address

516 W Frech St
Streator, IL 61364-1216

Phone

(815) 672-2600

Fax

(815) 672-2282

NPI assigned

Jul 8, 2006

Last updated

Feb 9, 2009By 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

Michael Lerner

Title

President

Phone

(815) 672-2600

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Camelot Terrace Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Parker Nursing & Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Streator, IL
  • NPI 1174822266
  NPD tax ID

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234137600000",
    "number": "1831122472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 W FRECH ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613641216",
            "telephone_number": "815-672-2600",
            "fax_number": "815-672-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 W FRECH ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613641216",
            "telephone_number": "815-672-2600",
            "fax_number": "815-672-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT TERRACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-02-09",
        "status": "A",
        "authorized_official_last_name": "LERNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-672-2600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0043877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL DEPT. PUBLIC HEALTH NU",
            "identifier": "0043877",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Kaye Black, DC
• James R Broedlow, RPH
• Rebecca Lynn Broedlow, MS SLP-CCC
• Felicia Brown, MA
• Bruce Sylvester Smith MD LLC
• Caner Celeboglu MD SC
• Carl P Mattioda MD and Chaoming Chen MDSC
• Jacob Casson
• Caner R Celeboglu, M.D.,F.A.C.S.
• Claire Chalkey, DMD

• Skilled Nursing Facility in Streator, IL
• Providers in Streator, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.