NPIMap

Organization Active NPI

Premier Healthcare Services, LLC

Doing business as Aveanna Healthcare

  • Home Health Agency
  • Orange, CA
National Provider Identifier
1326292897
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
550000829 Issued in CA
Legal business name
PREMIER HEALTHCARE SERVICES, LLC
Doing business as
Aveanna Healthcare
Practice address
625 The City Dr S
Suite 390
Orange, CA 92868-4924
Phone
(714) 834-1442
Fax
(714) 619-7666
NPI assigned
Nov 11, 2008
Last updated
Jan 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

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

Authorized official

Name
Matthew Buckhalter
Title
Cfo
Phone
(470) 464-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 550000829 CA Primary

Addresses

Primary practice location

625 The City Dr S
Suite 390
Orange, CA 92868-4924

Mailing address

400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000

Other identifiers 1

IdentifierTypeStateIssuer
1134306970OtherCAMEDICARE CMS 855A REQUIREMENT

Other names 1

  • Aveanna Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090401000307 CA Part A Provider - Home Health Agency 2264517697 Practice locations: Orange, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326292897. Details of each certification follow.

Home health agency certification: CCN 059107

Legal name
PREMIER HEALTHCARE SERVICES, LLC
Doing business as
AVEANNA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 5, 2009
Last certification
Jun 13, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Nov 7, 2005 in CA
Enrollment address
625 The City Dr S
Ste 390
Orange, CA 92868-6937

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Care Compare: Home health agency

Medicare Care Compare
Listed as
Aveanna HealthcareCCN 059107 · All quality measures
Ownership
Proprietary
Certified
Jun 5, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1093626Premier Healthcare Services, LLC625 The City Dr South Ste 390, Orange, CA 92868Certificate of waiverAug 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Premier Healthcare Services24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
J.H. Whitney VII LP Organization, New Canaan, CT For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 6.18%
Psa Healthcare Investment Holding LLC Organization, New Canaan, CT LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 7.14%
Aveanna Healthcare LLC Organization, Atlanta, GA LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 1, 2018 100%
Aveanna Healthcare Intermediate Holdings LLC Organization, Atlanta, GA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 100%
Aveanna Healthcare Holdings Inc Organization, Atlanta, GA Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 100%
Ronalyn Drobot Individual W-2 Managing EmployeeAd; Sep 1, 2024
Nut Tree Master Fund LP Organization, New York, NY For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2023 5.69%
Matthew Buckhalter Individual Corporate OfficerCfo Jul 7, 2023
Corporate DirectorCfo Jul 7, 2023
Hamilton Lane Co-Investment Fund III Holdings - 2 LP Organization, Bala Cynwyd, PA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 6.68%
Deborah Stewart Individual Corporate DirectorDirector Jul 7, 2023
Bain Capital Fund XI LP Organization, Boston, MA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jul 1, 2018 31.87%
Jerrold Perchik Individual Corporate OfficerSecretary Apr 29, 2024
Bcpe Eagle Investor, L.P. Organization, Boston, MA Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 37.52%
Jeffrey Shaner Individual Corporate OfficerCeo Jul 1, 2018
Corporate DirectorCeo Jan 1, 2023

Facilities with the same owner 122

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Stevenson Ranch, CA
    • NPI 1093946238

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • West Covina, CA
    • NPI 1104058122

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Sherman Oaks, CA
    • NPI 1114159381

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • San Jose, CA
    • NPI 1114246816

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Torrance, CA
    • NPI 1134306970

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Sacramento, CA
    • NPI 1275764417

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthacare

    • Home Health Agency
    • Victorville, CA
    • NPI 1295159366

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Alameda, CA
    • NPI 1396064093

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Psa Healthcare Investment Holding LLC

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • San Diego, CA
    • NPI 1437385010

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Culver City, CA
    • NPI 1437400165

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Temecula, CA
    • NPI 1669600284

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
  • Premier Healthcare Services, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Palmdale, CA
    • NPI 1811238967

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitney VII LP, Nut Tree Master Fu

    CMS ownership
View all 122

NPI Registry JSON

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738022400000",
    "number": "1326292897",
    "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": "470-464-8000",
            "fax_number": "770-248-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 THE CITY DR S",
            "address_2": "SUITE 390",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684924",
            "telephone_number": "714-834-1442",
            "fax_number": "714-619-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-11",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A",
        "authorized_official_last_name": "BUCKHALTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "470-464-8000"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "550000829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CMS 855A REQUIREMENT",
            "identifier": "1134306970",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.