Provider Demographics
NPI:1679581250
Name:CAMELOT COMMUNITY CARE, INC.
Entity Type:Organization
Organization Name:CAMELOT COMMUNITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AR
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-593-0003
Mailing Address - Street 1:4910 CREEKSIDE DR STE D
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-4034
Mailing Address - Country:US
Mailing Address - Phone:727-593-0003
Mailing Address - Fax:727-595-0735
Practice Address - Street 1:4910 CREEKSIDE DR STE D
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-4034
Practice Address - Country:US
Practice Address - Phone:727-593-0003
Practice Address - Fax:727-595-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871183Medicaid
FL070589600Medicaid
FL910585900Medicaid
FL070588800Medicaid
OH10400Medicaid
FL070593400Medicaid
FL070594202Medicaid
FL070587000Medicaid
FL070590000Medicaid
FL070595100Medicaid
FL070590001Medicaid
FL070592600Medicaid
IN200379750Medicaid
FL070591800Medicaid
FL070594200Medicaid
FL070595101Medicaid
FL761509400Medicaid
FL911092500Medicaid