| Camelot Care Centers, Llc. | |
|
5301 E State St Suite 208 Rockford IL 61108-2901 | |
| (815) 484-9180 | |
| (815) 484-9183 |
| Full Name | Camelot Care Centers, Llc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5301 E State St, Rockford, 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. 5301 E State St Suite 208 Rockford IL 61108-2901 Ph: (815) 484-9180 | Camelot Care Centers, Llc. 5301 E State St Suite 208 Rockford IL 61108-2901 Ph: (815) 484-9180 |
| NPI Number | 1023349081 |
|---|---|
| Provider Enumeration Date | 01/14/2010 |
| Last Update Date | 08/27/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023349081 | NPI | - | NPPES |
| 2B05-IPI-141 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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