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Organization
EXCALIBUR YOUTH SERVICES, LLC.
Active
Organization
EXCALIBUR YOUTH SERVICES, LLC.
Active
Other names
Venice Psychiatric Residential Treatment Facility, Broadstep Academy-SC Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ISABELLE WILLIAMS (MANAGER, REVENUE CYCLE)
(919) 703-2829
Entity
Organization
Contact information
Practice address
3683 S. INDUSTRIAL DR., SIMPSONVILLE, SC 29681
(864) 688-1133
(864) 962-6976
Mailing address
PO BOX 18346, PALATINE, IL 60055-0968
(919) 703-2829
(864) 294-1774
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
RTF-0022
SC
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RTF-0022
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENT CONTROL
SC
05
—
RTF055
—
SC
Enumeration date
01/21/2009
Last updated
08/22/2023
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