Camelot Residential Homes, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

198205266 Issued in CA

Legal business name

CAMELOT RESIDENTIAL HOMES, INC.

Practice address

8324 Crescent Ave
Buena Park, CA 90620-4024

Phone

(714) 827-0482

NPI assigned

Aug 6, 2014

Last updated

Aug 6, 2014By 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

Mr. Jefferson Aquino Bautista, N.P.

Title

President

Phone

(714) 827-0482

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1861801573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8324 CRESCENT AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906204024",
            "telephone_number": "714-827-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8324 CRESCENT AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906204024",
            "telephone_number": "714-827-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELOT RESIDENTIAL HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-06",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "JEFFERSON",
        "authorized_official_middle_name": "AQUINO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-827-0482",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "N.P."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "198205266",
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "CA",
            "license": "198205266",
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "CA",
            "license": "198205266",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jose Angel Caceres, MD
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• Victor C. Caluya, MD
• Elizabeth W Cammon
• Sarah Dallas Campanella
• Lindsey Miller Campos, M.A. CCC-SLP
• Zahire Campos
• Lillian Mae Cannady, MEDICAL ASSISTANCE

• Assisted Living Facility in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; 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.