Organization
CAMELOT SENIOR LIVING, INC.
Active
Other names
Camelot Care Home 1
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT EMERSON DAHLQUIST (PRESIDENT)
(916) 803-1955
Entity
Organization
Contact information
Practice address
8006 BUCKS HARBOR WAY, SACRAMENTO, CA 95828-5435
(916) 803-1955
(916) 685-6343
Mailing address
8716 MILO CT, ELK GROVE, CA 95624-1817
(916) 803-1955
(916) 685-6343
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RCF00027F
MEDI-CAL
CA
Enumeration date
05/22/2007
Last updated
08/22/2020
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