# CAMELOT PLACE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Camelot Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164776738
- **Authorized official:** NICOLE HOWARD (C.F.O. / C.O.O.)
- **Authorized official phone:** (318) 641-3717

## Contact information

- **Practice address:** 2021 CROWLEY RAYNE HWY, RAYNE, LA 70578-4027
- **Practice address phone:** (337) 783-8101
- **Practice address fax:** (888) 641-3781
- **Mailing address:** 4333 SHREVEPORT HWY, PINEVILLE, LA 71360-3828
- **Mailing address phone:** (318) 445-6470
- **Mailing address fax:** (318) 641-6282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/05/2012
- **Last updated:** 11/05/2012