| Entity Name: | CAMELOT HEALTHCARE MANAGEMENT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Nov 1998 (26 years ago) |
| Document Number: | P98000093195 |
| FEI/EIN Number | 650885369 |
| Address: | 3381 Us Highway 17 92 West, Haines City, FL, 33844, US |
| Mail Address: | 3363 Us Highway 17 92 West, Haines City, FL, 33844, US |
| ZIP code: | 33844 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720073679 | 2005-09-16 | 2018-01-26 | 3381 US HIGHWAY 17-92 WEST, HAINES CITY, FL, 33844, US | 3381 US HIGHWAY 17-92 WEST, HAINES CITY, FL, 33844, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 863-293-6533 |
| Fax | 8632934722 |
Authorized person
| Name | MR. ANGEL ARCIENO |
| Role | PRESIDENT |
| Phone | 3056325834 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | HME909 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | HME909 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025377400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOSS PHILIP E | Agent | 1172 S DIXIE HWY., CORAL GABLES, FL, 33146 |
| Name | Role | Address |
|---|---|---|
| Arciero Angel | Director | 3363 US Highway 17 92 W, Haines City, FL, 33844 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REINSTATEMENT | 2020-02-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
