| Camelot Care Centers, Llc | |
|
2396 W Nebraska Ave Peoria IL 61604-3111 | |
| (309) 676-6305 | |
| (309) 676-6519 |
| Full Name | Camelot Care Centers, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2396 W Nebraska Ave, Peoria, Illinois |
| Authorized Official Name and Position | Ronica Patel (STATE EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6307731985 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Camelot Care Centers, Llc 2396 W Nebraska Ave Peoria IL 61604-3111 Ph: (309) 676-6305 | Camelot Care Centers, Llc 2396 W Nebraska Ave Peoria IL 61604-3111 Ph: (309) 676-6305 |
| NPI Number | 1700149051 |
|---|---|
| Provider Enumeration Date | 06/21/2012 |
| Last Update Date | 06/04/2020 |
| Certification Date | 06/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700149051 | NPI | - | NPPES |
| 2B05-IPI-141 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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