Organization
CAMELOT RESIDENTIAL HOMES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERSON AQUINO BAUTISTA N.P. (PRESIDENT)
(714) 827-0482
Entity
Organization
Contact information
Practice address
8324 CRESCENT AVE, BUENA PARK, CA 90620-4024
(714) 827-0482
Mailing address
8324 CRESCENT AVE, BUENA PARK, CA 90620-4024
(714) 827-0482
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
198205266
CA
3104A0625X
Assisted Living Facility (Mental Illness)
198205266
CA
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
198205266
CA
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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