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General NPI Number Information
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NPI Number | 1679991301
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Entity Type | Organization
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Legal Business Name | HOSPICE & PALLIATIVE CARE CHARLOTTE REGION
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 1061 RED VENTURES DR STE 130
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City | FORT MILL
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State | SC
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Zip | 29707-2516
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Country | US
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Telephone | 803-548-3708
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Fax | 704-887-6450
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Provider Business Mailing Address
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Address Line | PO BOX 470408
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City | CHARLOTTE
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State | NC
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Zip | 28247-0408
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Country | US
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Telephone | 704-375-0100
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Fax | 704-887-6450
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. PETER A BRUNNICK
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Credential | C.P.A
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Telephone | 704-335-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | HPC-0047
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License Number State | SC
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