EXCALIBUR YOUTH SERVICES, LLC.
NPI 1710063375
Residential Treatment Facility, Emotionally Disturbed Children in Greenville, SC

Active since October 27, 2006
5321 OLD BUNCOMBE RD, GREENVILLE, SC 29609(864) 679-0023(864) 294-1774 Get Directions Write a Review

NPPES record last updated: March 11, 2008. Verified against the NPPES registry weekly; last sync: July 26, 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 1710063375) is a healthcare organization registered as a residential treatment facility, emotionally disturbed children in Greenville, South Carolina and active in the NPI registry since October 2006. The organization lists Marvin J. Short, Member, as its authorized official.

NPPES Registry Identity

NPI1710063375
Entity TypeOrganization
Primary Taxonomy322D00000X
Legal Business NameEXCALIBUR YOUTH SERVICES, LLC.
Location Address5321 OLD BUNCOMBE RDGreenville, SC 29609-0910
Mailing AddressPo Box 968Marietta, SC 29661-0968 · (864) 679-0023 · Fax (864) 294-1774
Fax(864) 294-1774
Organization SubpartNo
Authorized OfficialMarvin J. ShortMember · (864) 679-0023
Enumeration DateOctober 27, 2006
Last NPPES UpdateMarch 11, 2008
NPI 1710063375 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyResidential Treatment Facility, Emotionally Disturbed ChildrenResidential Treatment Facilities
Taxonomy Code322D00000X
License Licensed in SC · SR-0009711001-CCI
Definition

A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.

5321 OLD BUNCOMBE RD, Greenville, SC 29609

Other Identifiers 1

Medicaid907MXHSC

Other Providers at the Same Location NPPES

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

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
5321 OLD BUNCOMBE RD
GREENVILLE, SC 29609

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 1710063375. It was assigned to this organization in the NPPES registry on October 27, 2006.

Where is Excalibur Youth Services, LLC. located?

Excalibur Youth Services, LLC. is located at 5321 Old Buncombe Rd, Greenville, SC 29609. The listed phone number is (864) 679-0023.

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

The primary specialty registered for this NPI is Residential Treatment Facility, Emotionally Disturbed Children with taxonomy code 322D00000X.

When was this NPI record last updated?

The NPPES record for Excalibur Youth Services, LLC. was last updated on March 11, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.