Organization
PEDIATRIA HEALTHCARE, 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
53 GRAVEL ST, SUITE C, WILKES BARRE, PA 18705-3738
(770) 840-1966
(770) 840-1901
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021992800013
—
PA
Enumeration date
03/25/2009
Last updated
01/27/2025
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