Provider Demographics
NPI:1578560462
Name:BHM MEDICAL FACILITIES, LLC
Entity Type:Organization
Organization Name:BHM MEDICAL FACILITIES, LLC
Other - Org Name:CAMELOT NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-756-8911
Mailing Address - Street 1:705 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2161
Mailing Address - Country:US
Mailing Address - Phone:573-756-8911
Mailing Address - Fax:573-756-0862
Practice Address - Street 1:705 GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2161
Practice Address - Country:US
Practice Address - Phone:573-756-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031109314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101456200Medicaid
MO198617OtherBLUECROSS AND BLUE SHIELD
MO031109OtherFACILITY LICENSE NUMBER
MO101456200Medicaid
MO265348Medicare Oscar/Certification