Provider Demographics
NPI:1275536427
Name:HOSPICE OF CLEVELAND COUNTY, INC.
Entity type:Organization
Organization Name:HOSPICE OF CLEVELAND COUNTY, INC.
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:
Authorized Official - Last Name:BRUNNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-3501
Mailing Address - Street 1:951 WENDOVER HEIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3565
Mailing Address - Country:US
Mailing Address - Phone:704-487-4677
Mailing Address - Fax:704-481-8050
Practice Address - Street 1:951 WENDOVER HEIGHT DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3565
Practice Address - Country:US
Practice Address - Phone:704-487-4677
Practice Address - Fax:704-481-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QH0002X
NCHOS0371251G00000X
NCHOS1413251G00000X
SCHPC-065251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2497670OtherAETNA
0022WOtherBLUE CROSS BLUE SHIELD
355808OtherCIGNA
NC3401520Medicaid
SCHSP045Medicaid
355808OtherCIGNA
SCHSP045Medicaid