| Camelot Care Centers, Llc | |
|
2144 S Macarthur Blvd Springfield IL 62704-4502 | |
| (217) 585-9185 | |
| (217) 585-8522 |
| Full Name | Camelot Care Centers, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2144 S Macarthur Blvd, Springfield, Illinois |
| Authorized Official Name and Position | Ronica R 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 333 W Pierce Rd Ste 175 Itasca IL 60143-3120 Ph: (217) 585-9185 | Camelot Care Centers, Llc 2144 S Macarthur Blvd Springfield IL 62704-4502 Ph: (217) 585-9185 |
| NPI Number | 1740510338 |
|---|---|
| Provider Enumeration Date | 01/05/2010 |
| Last Update Date | 10/18/2021 |
| Certification Date | 10/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740510338 | 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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