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Organization

EXCALIBUR YOUTH SERVICES, LLC.

Active
Other names
Azalea Way
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MARVIN JOHN SHORT III JD (MEMBER)
(864) 313-6967
Entity
Organization

Contact information

Practice address
145 AZALEA WAY, HENDERSONVILLE, NC 28792-2409
(864) 836-7220
(864) 294-1774
Mailing address
PO BOX 968, TRAVELERS REST, SC 29690-0968
(864) 836-7220
(864) 294-1774

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL045-119
NC

Other

Enumeration date
09/18/2017
Last updated
09/18/2017
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