Provider Demographics
NPI:1417570771
Name:HOSPICE & PALLIATIVE CARE CHARLOTTE REGION
Entity Type:Organization
Organization Name:HOSPICE & PALLIATIVE CARE CHARLOTTE REGION
Other - Org Name:VIA HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUNNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-335-3501
Mailing Address - Street 1:PO BOX 470408
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-0408
Mailing Address - Country:US
Mailing Address - Phone:704-375-0100
Mailing Address - Fax:
Practice Address - Street 1:1057 RED VENTURES DR STE 150
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-2518
Practice Address - Country:US
Practice Address - Phone:803-548-3708
Practice Address - Fax:803-431-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8345Medicaid