Organization
CAMELOT COMMUNITY CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANA ALLEN (DIRECTOR OF AR)
(727) 593-0003
Entity
Organization
Contact information
Practice address
1801 SE HILLMOOR DR, PORT ST LUCIE, FL 34952-7553
(561) 649-0877
Mailing address
4910 CREEKSIDE DR STE D, CLEARWATER, FL 33760-4034
(727) 593-0003
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070592602
—
FL
Enumeration date
08/19/2021
Last updated
08/19/2021
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