Provider Demographics
NPI:1417219809
Name:CAMELOT HOME CARE SERVICES, INC
Entity Type:Organization
Organization Name:CAMELOT HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAGUNWA
Authorized Official - Suffix:
Authorized Official - Credentials:HHA
Authorized Official - Phone:202-379-5382
Mailing Address - Street 1:30 KENNEDY ST NW STE
Mailing Address - Street 2:110B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5219
Mailing Address - Country:US
Mailing Address - Phone:202-379-5382
Mailing Address - Fax:
Practice Address - Street 1:30 KENNEDY ST NW
Practice Address - Street 2:110B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5219
Practice Address - Country:US
Practice Address - Phone:202-379-5382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA 0274251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health