CAMELOT REALTY, LLC (NPI# 1184074650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184074650 |
| Entity Type | Organization |
| Organization Name | CAMELOT REALTY, LLC |
| Other Organization Name | JACKSON LANE |
| Practice Address |
1909 Jackson Lane Middletown OH 45042 |
| Mailing Address |
9901 Linn Station Rd Louisville KY 40223-3808 |
| Practice Telephone | 5138584550 |
| Mailing Telephone | 5023942100 |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-06-15 |
| Authorized Official Name | MARY A PANK (PARALEGAL) |
| Authorized Official Telephone | 5024202666 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Jackson Lane | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639529100 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4623 Central Avenue, Middletown, OH 45042 | 2016-06-15 |
| 1790135234 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4895 Hendrickson Rd., Middletown, OH 45042 | 2016-06-15 |
| 1720438294 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4907 Hendrickson Rd., Middletown, OH 45042 | 2016-06-15 |
| Street Address |
1909 JACKSON LANE |
| City | MIDDLETOWN |
| State | OH |
| Zip Code | 45042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801413919 | Stacey Ward | Nurse Practitioner | 1055 Summit Dr., Middletown, OH 45042 | 2020-07-06 |
| 1962978759 | Stephani Chandra Miller | Counselor | 160 N. Breiel Blvd, Middletown, OH 45042 | 2018-10-18 |
| 1124504378 | Butler County Community Health Consortium, Inc. | Clinic/Center | 601 N Breiel Blvd Ste B, Middletown, OH 45042 | 2018-07-11 |
| 1417474883 | Tiffany Marie Ott | Registered Nurse | 1229 Ellen Dr, Middletown, OH 45042 | 2017-08-27 |
| 1639529100 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4623 Central Avenue, Middletown, OH 45042 | 2016-06-15 |
| 1811347388 | Camelot Raalty, LLC | Intermediate Care Facility, Mentally Retarded | 4923 Hendrickson Rd, Middletown, OH 45042 | 2016-06-15 |
| 1790135234 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4895 Hendrickson Rd., Middletown, OH 45042 | 2016-06-15 |
| 1720438294 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4907 Hendrickson Rd., Middletown, OH 45042 | 2016-06-15 |
| 1174948129 | Sherry L. Flannery | Nurse Practitioner | 4961 Middletown Oxford Road, Middletown, OH 45042 | 2014-02-27 |
| 1053735662 | Susan E Rogers | Speech-Language Pathologist | 1 Donham Plaza, 4th Floor, Middletown, OH 45042 | 2014-02-18 |
| Find all providers in zip 45042 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639529100 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4623 Central Avenue, Middletown, OH 45042 | 2016-06-15 |
| 1811347388 | Camelot Raalty, LLC | Intermediate Care Facility, Mentally Retarded | 4923 Hendrickson Rd, Middletown, OH 45042 | 2016-06-15 |
| 1790135234 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4895 Hendrickson Rd., Middletown, OH 45042 | 2016-06-15 |
| 1720438294 | Camelot Realty, LLC | Intermediate Care Facility, Mentally Retarded | 4907 Hendrickson Rd., Middletown, OH 45042 | 2016-06-15 |
| 1780800870 | Abilities First | Intermediate Care Facility, Mentally Retarded | 1009 Grove Street, None, Middletown, OH 45044-5890 | 2007-04-17 |
| 1386778546 | Crystal Run Village, Inc | Intermediate Care Facility, Mentally Retarded | 601 Stony Ford Rd, Middletown, NY 10941-3951 | 2007-03-16 |
| 1285789412 | Bridges Inc | Intermediate Care Facility, Mentally Retarded | 8 Toni Lynn Ter, Middletown, RI 02842-5917 | 2007-01-25 |
| 1740354489 | Graceworks Enhanced Living | Intermediate Care Facility, Mentally Retarded | 403 Curtis St, Middletown, OH 45044-4315 | 2006-11-17 |
| 1619149077 | Crystal Run Village Inc | Intermediate Care Facility, Mentally Retarded | 601 Stony Ford Rd, Middletown, NY 10941-3951 | 2008-03-26 |
| 1619149069 | Crystal Run Village Inc | Intermediate Care Facility, Mentally Retarded | 601 Stony Ford Rd, Middletown, NY 10941-3951 | 2008-03-26 |
| Find all providers in MIDDLETOWN | ||||
| City | MIDDLETOWN |
| Zip Code | 45042 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.