Provider Demographics
NPI:1851508717
Name:THE CAMELOT SOCIETY
Entity Type:Organization
Organization Name:THE CAMELOT SOCIETY
Other - Org Name:BEDFORD GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-481-5853
Mailing Address - Street 1:18606 BOTHELL WAY NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1929
Mailing Address - Country:US
Mailing Address - Phone:425-481-5853
Mailing Address - Fax:425-481-5763
Practice Address - Street 1:12461 NE 173RD PL
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7925
Practice Address - Country:US
Practice Address - Phone:425-481-5853
Practice Address - Fax:425-481-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4967105OtherICFMR GROUP HOME