Organization Name: | EXCELLENT SPIRIT ENTERPRISE, INC. |
NPI Number: | 1760715486 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN ROBERT PICKETT (FOUNDER/CEO) |
Mailing Address: | 9201 County Line Road Sharpsburg |
State: | NC US |
Postal Code: | 278789998 |
Phone Number: | 2524464455 |
Fax Number: | 7046250372 |
NPI Enumeration Date: | 09/14/2009 |
NPI Last Update Date: | 03/29/2011 |
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: |