| Organization Name: | EXCELLENT SPIRIT ENTERPRISE, INC. |
| NPI Number: | 1619033115 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN R. PICKETT (PROVIDER) |
| Mailing Address: | 9201 County Line Road Sharpsburg |
| State: | NC US |
| Postal Code: | 278780098 |
| Phone Number: | 2524464455 |
| Fax Number: | |
| NPI Enumeration Date: | 12/29/2006 |
| NPI Last Update Date: | 01/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 200000114 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |