Organization
THE CAMELOT SOCIETY
Active
Other names
Camelot Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
AUTUMN L. CALKINS (EXECUTIVE DIRECTOR)
(425) 481-5853
Entity
Organization
Contact information
Practice address
9201 2ND AVE NW, SEATTLE, WA 98117-2012
(425) 481-5853
(425) 481-5763
Mailing address
18606 BOTHELL WAY NE, BOTHELL, WA 98011-1929
(425) 481-5853
(425) 481-5763
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4967501
ICFMR GROUP HOME
WA
Enumeration date
05/17/2007
Last updated
08/22/2020
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