Provider Demographics
NPI:1851508717
Name:THE CAMELOT SOCIETY
Entity type:Organization
Organization Name:THE CAMELOT SOCIETY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-422-5563
Mailing Address - Street 1:6912 220TH ST SW STE 301
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2171
Mailing Address - Country:US
Mailing Address - Phone:425-771-2108
Mailing Address - Fax:425-771-2126
Practice Address - Street 1:6912 220TH ST SW STE 301
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2171
Practice Address - Country:US
Practice Address - Phone:425-771-2108
Practice Address - Fax:425-771-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4967105OtherDSHS