| Excalibur Youth Services, Llc. | |
|
3683 S Industrial Dr Simpsonville SC 29681-3238 | |
| (864) 836-7220 | |
| Not Available |
| Full Name | Excalibur Youth Services, Llc. |
|---|---|
| Speciality | Family Medicine |
| Location | 3683 S Industrial Dr, Simpsonville, South Carolina |
| Authorized Official Name and Position | John M Short (CEO) |
| Authorized Official Contact | 8648367220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Excalibur Youth Services, Llc. Po Box 968 Travelers Rest SC 29690-0968 Ph: (864) 836-7220 | Excalibur Youth Services, Llc. 3683 S Industrial Dr Simpsonville SC 29681-3238 Ph: (864) 836-7220 |
| NPI Number | 1487174462 |
|---|---|
| Provider Enumeration Date | 06/21/2017 |
| Last Update Date | 06/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487174462 | NPI | - | NPPES |
| 1083852511 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (South Carolina) | Primary |
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