THE CAMELOT SOCIETY (NPI# 1538377064) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538377064 |
| Entity Type | Organization |
| Organization Name | THE CAMELOT SOCIETY |
| Other Organization Name | CARLTON GROUP HOME |
| Practice Address |
26509 N.e. Virginia St. Duvall WA 98019 |
| Mailing Address |
18606 Bothell Way Ne Bothell WA 98011-1929 |
| Practice Telephone | 4254815853 |
| Practice Fax Number | 4254815763 |
| Mailing Telephone | 4254815853 |
| Mailing Fax Number | 4254815763 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | AUTUMN L. CALKINS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4254815853 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | ICFMR GROUP HOME | 4966800 | 01 |
| Other Name | Type Code |
|---|---|
| Carlton Group Home | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629286158 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 17235 126th Pl Ne, Woodinville, WA 98072-7923 | 2007-05-18 |
| 1518174564 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 9201 2nd Ave Nw, Seattle, WA 98117-2012 | 2007-05-17 |
| 1811104763 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 5027 Ne 188th St, Lake Forest Park, WA 98155-3012 | 2007-05-17 |
| 1851508717 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 12461 Ne 173rd Pl, Woodinville, WA 98072-7925 | 2007-05-17 |
| 1790992683 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 26511 Ne Virginia St, Duvall, WA 98019-8461 | 2007-05-17 |
| Street Address |
26509 N.E. VIRGINIA ST. |
| City | DUVALL |
| State | WA |
| Zip Code | 98019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598240202 | Emily Ellen Squiers | Counselor | 26420 Virginia St, Suite 2, Duvall, WA 98019 | 2018-09-27 |
| 1235629072 | Aubrey Christine Lane | Marriage & Family Therapist | Larch Counseling 15315 1st Avenue Northeast, #205-a, Duvall, WA 98019 | 2018-05-17 |
| 1528505575 | Jackie Schaedler Boak | Registered Nurse | 15309 2nd Ave Ne, Duvall, WA 98019 | 2017-01-30 |
| 1912326778 | Dan Claussen | Marriage & Family Therapist | 15315 Ne 1st Ave Ne, Suite 205-a, Duvall, WA 98019 | 2014-04-09 |
| 1134405509 | Amy R Bush | Physical Therapist | 15435 Main St. Ne #101, Duvall, WA 98019 | 2011-10-28 |
| 1407134919 | Cynthia Rebecca Tyler | Dentist | 26504 Ne Valley Street, Duvall, WA 98019 | 2011-08-01 |
| 1215256730 | Diane Zakrajsek | Dietitian, Registered | 26502 Ne Valley Street Suite 102, Duvall, WA 98019 | 2010-05-24 |
| 1093917320 | Jolynn Wagner | Psychologist | 26502 Ne Valley St Suite 101, Duvall, WA 98019 | 2007-05-31 |
| 1760690242 | Rebecca Jean Maxcy | Specialist | 15705 Main St, Duvall, WA 98019 | 2007-05-18 |
| 1215143706 | Michele Marie Sullivan | Marriage & Family Therapist | 15315 1st Ave Ne, #212, Duvall, WA 98019 | 2007-05-14 |
| Find all providers in zip 98019 | ||||
| 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 |
|---|---|---|---|---|
| 1790992683 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 26511 Ne Virginia St, Duvall, WA 98019-8461 | 2007-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154512150 | Social & Health Services Frances Haddon Morgan Cc | Intermediate Care Facility, Mentally Retarded | 3423 6th St, Bremerton, WA 98312-3555 | 2007-08-05 |
| 1669671095 | United Friends Group Friends | Intermediate Care Facility, Mentally Retarded | 6935 Fauntleroy Way Sw, Seattle, WA 98136-1728 | 2007-07-16 |
| 1629286158 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 17235 126th Pl Ne, Woodinville, WA 98072-7923 | 2007-05-18 |
| 1518174564 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 9201 2nd Ave Nw, Seattle, WA 98117-2012 | 2007-05-17 |
| 1811104763 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 5027 Ne 188th St, Lake Forest Park, WA 98155-3012 | 2007-05-17 |
| 1851508717 | The Camelot Society | Intermediate Care Facility, Mentally Retarded | 12461 Ne 173rd Pl, Woodinville, WA 98072-7925 | 2007-05-17 |
| 1366594228 | Lakeland Village | Intermediate Care Facility, Mentally Retarded | S 2320 Salnave Road, Medical Lake, WA 99022-0200 | 2007-01-18 |
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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.