Organization
PEDIATRIC HOME CARE, INC.
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
1120 NORTH MULLAN ROAD, SUITE 206, SPOKANE VALLEY, WA 99206-4074
(509) 368-9252
(509) 368-9594
Mailing address
400 INTERSTATE NORTH PKWY SE STE 1600, ATLANTA, GA 30339-5047
(470) 464-8000
(770) 248-8192
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
00000344
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0213350
—
MT
05
—
0561646
—
MT
05
—
6025159
—
WA
05
—
7331622
—
WA
05
—
806189200
—
ID
05
—
806198700
—
ID
05
—
9051780
—
WA
Enumeration date
05/09/2006
Last updated
01/27/2025
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