EXCALIBUR YOUTH SERVICES LLC. NPI 1073032470

NPI Information

  • NPI: 1073032470
  • Provider Name: EXCALIBUR YOUTH SERVICES, LLC.
  • Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
  • Entity Type: Organization
  • Doing Business As: AZALEA WAY
  • Address: 145 AZALEA WAY
    HENDERSONVILLE, NC
    ZIP 28792
  • Phone: (864) 836-7220

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NPI Details

EXCALIBUR YOUTH SERVICES, LLC. is a community based residential treatment facility mental illness in Hendersonville, NC. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. EXCALIBUR YOUTH SERVICES, LLC. NPI is 1073032470. The provider is registered as an organization entity type.
The provider Is Doing Business As Azalea Way.

The provider's business location address is:

145 AZALEA WAY
HENDERSONVILLE, NC
ZIP 28792-409
Phone: (864) 836-7220
Fax: (864) 294-1774

The provider's authorized official is Marvin John Short .
The authorized official title is Member and has the following contact phone number (864) 313-6967.

The enumeration date for this NPI number is 9/18/2017 and was last updated on 9/18/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320800000XCommunity Based Residential Treatment Facility, Mental IllnessMHL045-119NORTH CAROLINAYes

What is NPI?

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This page was last updated on: 11/21/2025

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