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
760 NORTH DRIVE, SUITE E & F, MELBOURNE, FL 32934
(321) 253-2000
Mailing address
400 INTERSTATE NORTH PKWY SE STE 1600, ATLANTA, GA 30339-5047
(470) 464-8000
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
884161601
—
FL
Enumeration date
08/13/2021
Last updated
01/27/2025
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