Organization
EXCALIBUR YOUTH SERVICES, LLC.
Active
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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