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EXCALIBUR YOUTH SERVICES, LLC.
NPI 1487174462
Family Medicine in Simpsonville, SC

Active since June 21, 2017
3683 S INDUSTRIAL DR, SIMPSONVILLE, SC 29681(864) 836-7220 Get Directions Write a Review

NPPES record last updated: June 21, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Excalibur Youth Services, Llc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EXCALIBUR YOUTH SERVICES, LLC. (NPI 1487174462) is a healthcare organization registered as a family medicine in Simpsonville, South Carolina and active in the NPI registry since June 2017. The organization lists John M Short, Ceo, as its authorized official.

NPPES Registry Identity

NPI1487174462
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEXCALIBUR YOUTH SERVICES, LLC.
Location Address3683 S INDUSTRIAL DRSimpsonville, SC 29681-3238
Mailing AddressPo Box 968Travelers Rest, SC 29690-0968 · (864) 836-7220
Phone(864) 836-7220
Organization SubpartNo
Authorized OfficialJohn M ShortCeo · (864) 836-7220
Enumeration DateJune 21, 2017
✔ NPI 1487174462 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
3683 S INDUSTRIAL DR, Simpsonville, SC 29681
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Other Identifiers 1

Medicaid1083852511SC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GINO RUBENS LMHC, LPC
Counselor (Professional)
3683 S INDUSTRIAL DR
SIMPSONVILLE, SC 29681
Greenville County (954) 296-9924

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Excalibur Youth Services, LLC.'s NPI number?

The NPI number for Excalibur Youth Services, LLC. is 1487174462. It was assigned to this organization in the NPPES registry on June 21, 2017.

Where is Excalibur Youth Services, LLC. located?

Excalibur Youth Services, LLC. is located at 3683 S Industrial Dr, Simpsonville, SC 29681. The listed phone number is (864) 836-7220.

What is Excalibur Youth Services, LLC.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Excalibur Youth Services, LLC. was last updated on June 21, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.