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Organization
PEDIATRIC SERVICES OF AMERICA, LLC
Active
Organization
PEDIATRIC SERVICES OF AMERICA, LLC
Active
Other names
Aveanna Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BUCKHALTER (CFO)
(470) 464-8000
Entity
Organization
Contact information
Practice address
1456 E LACKAWANNA ST, OLYPHANT, PA 18447-2151
(570) 319-2053
(570) 591-1801
Mailing address
400 INTERSTATE NORTH PKWY SE STE 1600, ATLANTA, GA 30339-5047
(470) 464-8000
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05040501
HHA LICENSE
PA
Enumeration date
05/23/2012
Last updated
01/27/2025
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