NPI 1710063375

Excalibur Youth Services, LLC.

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Greenville, SC

Practice location

Address: 5321 Old Buncombe Rd, Greenville, SC 29609-0910
Phone: (864) 679-0023
Fax: (864) 294-1774
Mailing address: PO Box 968, Marietta, SC 29661-0968

Authorised official

Name: Marvin J. Short
Title: Member
Phone: (864) 679-0023

Registered specialties (2)

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X Licence SR-0009711001-CCI (SC)

Other Residential Treatment Facility, Emotionally Disturbed Children providers in South Carolina →

Mental Illness Community Based Residential Treatment Facility

Residential Treatment Facilities Taxonomy 320800000X

Other Community Based Residential Treatment Facility, Mental Illness providers in South Carolina →

Registry record

NPI: 1710063375
Entity type: Organization
NPI issued: 27 Oct 2006
Record last updated: 11 Mar 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.