NPIMap

Organization Active NPI

Pediatric Services of America, LLC

  • Nursing Care Agency
  • Vancouver, WA
National Provider Identifier
1114956646
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
Legal business name
PEDIATRIC SERVICES OF AMERICA, LLC
Practice address
2700 NE Andresen Rd
Suite D-3
Vancouver, WA 98661-7347
Phone
(360) 693-7595
Fax
(360) 693-7262
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vicki Whiteside
Title
Avp, Regulatory Licensing
Phone
(770) 248-8740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X Primary

Addresses

Primary practice location

2700 NE Andresen Rd
Suite D-3
Vancouver, WA 98661-7347

Mailing address

400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (770) 441-1580

Other identifiers 2

IdentifierTypeStateIssuer
9049561MedicaidWA
746106MedicaidWA

Other names 2

  • Aveanna Healthcare Doing business as
  • PSA Healthcare Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sleep Disorder Serv of76 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 4

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

2700 NE Andresen Rd
Ste D3
Vancouver, WA 98661
Phone (360) 693-7595

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1114956646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 INTERSTATE NORTH PKWY SE STE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395047",
            "telephone_number": "770-441-1580",
            "fax_number": "770-248-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 NE ANDRESEN RD",
            "address_2": "SUITE D-3",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617347",
            "telephone_number": "360-693-7595",
            "fax_number": "360-693-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "WHITESIDE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "AVP, REGULATORY LICENSING",
        "authorized_official_telephone_number": "770-248-8740"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9049561",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "746106",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PSA Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.