Provider Demographics
NPI:1366630162
Name:CAMERON COURT, LLC
Entity Type:Organization
Organization Name:CAMERON COURT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TEBONY
Authorized Official - Middle Name:CAMISHA
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-273-0489
Mailing Address - Street 1:4642 W MARKET ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1285
Mailing Address - Country:US
Mailing Address - Phone:336-273-0489
Mailing Address - Fax:336-271-2906
Practice Address - Street 1:1002 JULIAN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2153
Practice Address - Country:US
Practice Address - Phone:336-273-0489
Practice Address - Fax:336-271-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL041830322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children