Provider Demographics
NPI:1679991301
Name:HOSPICE & PALLIATIVE CARE CHARLOTTE REGION
Entity type:Organization
Organization Name:HOSPICE & PALLIATIVE CARE CHARLOTTE REGION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUNNICK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:704-335-3501
Mailing Address - Street 1:PO BOX 470408
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-0408
Mailing Address - Country:US
Mailing Address - Phone:704-375-0100
Mailing Address - Fax:704-887-6450
Practice Address - Street 1:1061 RED VENTURES DR STE 130
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-2516
Practice Address - Country:US
Practice Address - Phone:803-548-3708
Practice Address - Fax:704-887-6450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE & PALLIATIVE CARE CHARLOTTE REGION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-31
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QH0002X
SCHPC-0047251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP151Medicaid
SC421626OtherMEDICARE
SCH031OtherMEDICARE PART B