Organization
PEDIATRIC SERVICES OF AMERICA, LLC
Active
Other names
Aveanna Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI WHITESIDE (AVP REGULATORY LICENSING)
(470) 464-8000
Entity
Organization
Contact information
Practice address
7602 BRIDGEPORT WAY W, SUITE 2B, LAKEWOOD, WA 98499-2415
(253) 912-4860
(253) 912-4862
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
251J00000X
Nursing Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IHS.FS.00000423
WASHINGTON STATE DEPT OF HEALTH
WA
Enumeration date
02/18/2008
Last updated
04/09/2021
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