EXCALIBUR YOUTH SERVICES, LLC.


Address: 5321 Old Buncombe Rd, Greenville, SC 29609-0910
Phone: 8646790023

EXCALIBUR YOUTH SERVICES, LLC. (NPI# 1710063375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1710063375
Entity Type Organization
Organization Name EXCALIBUR YOUTH SERVICES, LLC.
Practice Address 5321 Old Buncombe Rd
Greenville
SC 29609-0910
Mailing Address Po Box 968
Marietta
SC 29661-0968
Practice Telephone 8646790023
Practice Fax Number 8642941774
Mailing Telephone 8646790023
Mailing Fax Number 8642941774
Enumeration Date 2006-10-27
Last Update Date 2008-03-11
Authorized Official Name MR. MARVIN J. SHORT III (MEMBER)
Authorized Official Telephone 8646790023
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 320800000X Community Based Residential Treatment Facility, Mental Illness Residential Treatment Facilities
Y 322D00000X Residential Treatment Facility, Emotionally Disturbed Children SR-0009711001-CC SC Residential Treatment Facilities

Other Provider Identifier

State Issuer Identifier Type Code
SC 907MXH 05

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1487174462 Excalibur Youth Services, LLC. Family Medicine 3683 S Industrial Dr, Simpsonville, SC 29681-3238 2017-06-21
1083852511 Excalibur Youth Services, LLC. Psychiatric Residential Treatment Facility 3683 S. Industrial Dr., Simpsonville, SC 29681 2009-01-21
1073032470 Excalibur Youth Services, LLC. Community Based Residential Treatment Facility, Mental Illness 145 Azalea Way, Hendersonville, NC 28792-2409 2017-09-18

Office Location

Street Address 5321 OLD BUNCOMBE RD
City GREENVILLE
State SC
Zip Code 29609-0910

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1326522376 Piney Mountain Rx LLC Pharmacy 2498 North Pleasantburg Drive, Suite A, Greenville, SC 29609 2018-09-17
1417434655 Kathryn Dorothy Muschick Pediatrics 900 W. Faris Dr., Greenville, SC 29609 2018-07-20
1942705645 The Wright Home Care, LLC Social Worker 217 E Stone Ave Ste 8, Greenville, SC 29609 2018-03-26
1205388386 Galina Hufstetler Physical Therapist 414 Summit Drive, Apt. 313, Greenville, SC 29609 2016-10-25
1811303225 Cal Jones LLC Pharmacy 961 Montebello Dr, Suite 2, Greenville, SC 29609 2014-07-07
1982954319 John C Shaughnessy Pharmacist 1141 State Park Road, Greenville, SC 29609 2012-09-13
1770842726 Neil S Sondov Counselor 1100 Rutherford Road, Greenville, SC 29609 2012-05-11
1790044915 Crystal Ervin Counselor 1 Chick Springs Rd Ste 210a, Greenville, SC 29609 2012-05-08
1881992840 Cherrydale Dental Associates, LLC Dentist 105 State Park Rd, Greenville, SC 29609 2011-03-01
1649584483 Paul E Waters Pharmacist 1 East Stone Ave, Greenville, SC 29609 2010-08-04
Find all providers in zip 29609

Taxonomy Information

Taxonomy Code 322D00000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Emotionally Disturbed Children

Taxonomy Definition

A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment.
Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1467892661 Doretha Community Development Residential Treatment Facility, Emotionally Disturbed Children 3313 Brookline Ct, Greenville, NC 27834-8498 2013-07-02
1093968836 A Second Chance,inc Residential Treatment Facility, Emotionally Disturbed Children 1209 Duce Dr, Greenville, NC 27834-6566 2008-10-24
1336316892 Noacin, Inc. Residential Treatment Facility, Emotionally Disturbed Children 924 Ellery Dr, Greenville, NC 27834-0066 2008-05-14
1396927976 Healthplus Therapeutic Services Inc Residential Treatment Facility, Emotionally Disturbed Children 205 Greenbriar Dr, Greenville, NC 27834-9699 2007-12-05
1235328881 My Savior Family Care Home, Inc. Residential Treatment Facility, Emotionally Disturbed Children 3200 Briarcliff Dr, Greenville, NC 27834-4948 2007-10-19
1497963136 Divine Guidance Integrative Services Residential Treatment Facility, Emotionally Disturbed Children 321 Scottish Ct, Greenville, NC 27858-8974 2007-05-18
1326254582 Divine Guidance Integrative Services Residential Treatment Facility, Emotionally Disturbed Children 1306 Dusk Ct, Greenville, NC 27834-7785 2007-05-15
1629293592 Dream Provider Care Services Residential Treatment Facility, Emotionally Disturbed Children 2272 Briley Rd, Greenville, NC 27834-8909 2007-04-16
1699804302 Cascade Behavioral Treatment Services, Inc Residential Treatment Facility, Emotionally Disturbed Children 325 Oak Grove Ave, Greenville, NC 27834-1124 2007-03-06
1720116072 Infinity Options Residential Facility Residential Treatment Facility, Emotionally Disturbed Children 122 Fletcher Pl, Greenville, NC 27858-4723 2007-03-01
Find all providers in GREENVILLE

Competitor

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City GREENVILLE
Zip Code 29609

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Dataset Information

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.

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