Healthcare Provider Details

I. General information

NPI: 1275536427
Provider Name (Legal Business Name): HOSPICE OF CLEVELAND COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 WENDOVER HEIGHT DR
SHELBY NC
28150-3565
US

IV. Provider business mailing address

951 WENDOVER HEIGHT DR
SHELBY NC
28150-3565
US

V. Phone/Fax

Practice location:
  • Phone: 704-487-4677
  • Fax: 704-481-8050
Mailing address:
  • Phone: 704-487-4677
  • Fax: 704-481-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHOS0371
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHPC-065
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHOS1413
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PETER BRUNNICK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 704-355-3501