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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
SC | 907MXH | 05 |
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 |
Street Address |
5321 OLD BUNCOMBE RD |
City | GREENVILLE |
State | SC |
Zip Code | 29609-0910 |
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 Code | 322D00000X |
Grouping | Residential Treatment Facilities |
Classification | Residential Treatment Facility, Emotionally Disturbed Children |
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. |
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 |
City | GREENVILLE |
Zip Code | 29609 |
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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.