MEDICARE: HOSPICE OF CLEVELAND COUNTY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
2	251G00000X	Community Based Hospice Care Agency	HOS0371	NC
3	251G00000X	Community Based Hospice Care Agency	HPC-065	SC
4	251G00000X	Community Based Hospice Care Agency	HOS1413	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2497670	OTHER	AETNA
2	0022W	OTHER	BLUE CROSS BLUE SHIELD
3	355808	OTHER	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275536427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF CLEVELAND COUNTY, INC.

Provider Business Mailing Address
First Line	:	951 WENDOVER HEIGHT DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3565
Country	:	US
Telephone Number	:	704-487-4677
Fax Number	:	704-481-8050

Provider Business Practice Location Address
First Line	:	951 WENDOVER HEIGHT DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3565
Country	:	US
Telephone Number	:	704-487-4677
Fax Number	:	704-481-8050

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. PETER BRUNNICK
Credential	:
Telephone Number	:	704-355-3501

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/24/2025

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