VENICE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY – NPI #1083852511
Psychiatric Residential Treatment Facility

A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary

VENICE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY is a psychiatric residential treatment facility located in SIMPSONVILLE, SC. NPPES has assigned the NPI number 1083852511 to VENICE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY on January 21, 2009. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “VENICE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY” is a dba name, the actual legal business name for this organization is EXCALIBUR YOUTH SERVICES, LLC.. This provider is also associated with 2 additional names listed below. According to the NPI data, there are 2 additional location(s) assigned to this provider which are listed below. The primary taxonomy selected by this provider is 323P00000X from the Health Care Provider Taxonomy code set, which is classified as Psychiatric Residential Treatment Facility.

The NPI profile was previously updated about 3 years ago on Aug 22, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for VENICE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY below.

NPI Profile for
EXCALIBUR YOUTH SERVICES, LLC.

NPI Number
1083852511
Enumeration Date

(more than 17 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
EXCALIBUR YOUTH SERVICES, LLC.
Doing Business As (dba): VENICE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY
Other name(s)
All associated names:
Doing Business As (dba)
Broadstep Academy-SC Inc
Doing Business As (dba)
Venice Psychiatric Residential Treatment Facility
Primary location
3683 S. INDUSTRIAL DR.
SIMPSONVILLE, SC 29681
Phone: (864) 688-1133 Fax: (864) 962-6976
2 Other location(s):
1370 N Williamsburg County Hwy
Kingstree, SC 29556-7027
Phone: (864) 836-7220
404 Hampton Ave
Pickens, SC 29671-2608
Phone: (864) 679-0023
Fax: (864) 294-1774
Mailing address
PO BOX 18346
PALATINE, IL 60055-0968
Phone: (919) 703-2829 Fax: (864) 294-1774
Organization Subpart
No
Authorized Official
ISABELLE WILLIAMS
MANAGER, REVENUE CYCLE
Phone: (919) 703-2829
Updated
Certification Date
Aug 22, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for VENICE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherSOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENT CONTROLSCRTF-0022
medicaidSCRTF055
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
323P00000X
- Psychiatric Residential Treatment Facility (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Endpoint

Health Information Exchange (HEI)

HEI is the mobilization of health care information electronically across organizations within a region, community or hospital system. Endpoints provide a simple and secure way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet such as primary care physicians, specialists, hospitals, labs, etc.

Endpoint
Raleigh
Endpoint type
Other URL
Endpoint Description
Content Type
Affiliation
N
Endpoint Location
3683 S. INDUSTRIAL DR.,
SIMPSONVILLE, SC 77025-1669