NPIMap

Organization Active NPI

Camelot Care Centers, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Rockford, IL
National Provider Identifier
1831797141
Registry record updated Oct 18, 2021
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
5301 E State St Ste 208
Rockford, IL 61108-2397
Phone
(815) 484-9180
NPI assigned
Oct 9, 2020
Organization subpart
Yes
Parent organization
PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

5301 E State St Ste 208
Rockford, IL 61108-2397

Mailing address

333 W Pierce Rd Ste 175
Itasca, IL 60143-3120

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 LLC

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": "1602201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1831797141",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E STATE ST STE 208",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082397",
            "telephone_number": "815-484-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT CARE CENTERS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC.",
        "enumeration_date": "2020-10-09",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RONICA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-773-1985"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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.