Healthcare Provider Details

I. General information

NPI: 1679991301
Provider Name (Legal Business Name): HOSPICE & PALLIATIVE CARE CHARLOTTE REGION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 RED VENTURES DR STE 130
FORT MILL SC
29707-2516
US

IV. Provider business mailing address

PO BOX 470408
CHARLOTTE NC
28247-0408
US

V. Phone/Fax

Practice location:
  • Phone: 803-548-3708
  • Fax: 704-887-6450
Mailing address:
  • Phone: 704-375-0100
  • Fax: 704-887-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHPC-0047
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PETER A BRUNNICK
Title or Position: PRESIDENT/CEO
Credential: C.P.A
Phone: 704-335-3501