Excalibur Youth Services, Llc.

LBN: Excalibur Youth Services, Llc.
Excalibur Youth Services, Llc. is an health care organization with primary practice located at 5321 Old Buncombe Rd , Greenville SC 29609-0910. The organization recently has 2 registered licenses in different health care specialties including Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness, Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children. Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children is the primary health care specialty. Excalibur Youth Services, Llc. can be contacted via phone (864) 679-0023, or through Short, Marvin J. via phone (864) 679-0023.

Contact Information

Primary practice address
5321 Old Buncombe Rd Greenville SC 29609-0910
Phone: (864) 679-0023
Fax: (864) 294-1774
Website:
Map and Directions
Authorized official contact:
Name: Short, Marvin J.
Phone: (864) 679-0023

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness 320800000X
Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children 322D00000X SR-0009711001-CCI South Carolina

Profile Details

NPI number 1710063375
LBN Legal business name Excalibur Youth Services, Llc.
DBA Doing business as
Authorized official Short, Marvin J.
Entity Organization
Organization subpart 1 No
Enumeration date Oct 27th, 2006
Last updated Mar 11th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710063375 NPPES
South Carolina MEDICAID 907MXH

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