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
2005 VISTA PKWY, SUITE 110 A, WEST PALM BEACH, FL 33411-2719
(561) 683-5758
(561) 683-3416
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
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
PPC6010096
FL
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300198900
—
FL
05
—
300204700
—
FL
05
—
884708800
—
FL
Enumeration date
07/25/2006
Last updated
01/27/2025
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