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
5569 BROADCAST CT, LAKEWOOD RANCH, FL 34240-8472
(941) 254-4900
(941) 355-2210
Mailing address
4910 CREEKSIDE DR STE D, CLEARWATER, FL 33760-4034
(727) 593-0003
(727) 595-0735
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253J00000X
Foster Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070590001
—
FL
Enumeration date
01/26/2016
Last updated
07/13/2021
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