Pediatric Services of America, LLC
Organization Active NPI Home Health Agency · Olyphant, PA
NPI 1487914495 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1487914495
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- PEDIATRIC SERVICES OF AMERICA, LLC
- Practice address
- 1456 E Lackawanna St
Olyphant, PA 18447-2151 - Phone
- (570) 319-2053
- Fax
- (570) 591-1801
- NPI assigned
- May 23, 2012
- Organization subpart
- No
Authorized official
- Name
- Matthew Buckhalter
- Title
- Cfo
- Phone
- (470) 464-8000
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 19
Corporate family (same tax ID) 6
Facilities with the same owner 122
Medicare Care Compare: Home health agency
- Listed as
- Aveanna Healthcare
- Ownership
- Proprietary
- Certified
- Dec 12, 2013
- Medicare certification status
- Active
- Services
- Nursing, Home health aide
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2052714 | Pediatric Services of America, LLC | Certificate of waiver | Jan 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Home health agency certification: CCN 398213
- Legal name
- PEDIATRIC SERVICES OF AMERICA, LLC
- Doing business as
- AVEANNA HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Dec 12, 2013
- Last certification
- Jun 17, 2016
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 28, 2020 in GA
- Enrollment address
- 1456 E Lackawanna St
Olyphant, PA 18447-2151
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| J.H. Whitney VII LP |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 16.09% |
| Psa Healthcare Investment Holding LLC |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 8.04% |
| Aveanna Healthcare LLC |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 100% |
| Matthew Marriggi |
W-2 Managing Employee |
Apr 21, 2025 | |
| Aveanna Healthcare Intermediate Holdings LLC |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 100% |
| Pediatric Services Holding LLC |
5% Or Greater Indirect Ownership Interest | Aug 31, 2007 | 100% |
| Aveanna Healthcare Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 100% |
| Nut Tree Master Fund LP |
5% Or Greater Indirect Ownership Interest | Dec 31, 2023 | 6.34% |
| Matthew Buckhalter |
Corporate Officer |
Jul 7, 2023 | |
| Corporate Director |
Jul 7, 2023 | ||
| Bcip Associates IV US L.P. |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 5.35% |
| Hamilton Lane Co-Investment Fund III Holdings - 2 LP |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 7.5% |
| Deborah Stewart |
Corporate Director |
Jul 7, 2023 | |
| Bain Capital Fund XI LP |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 35.54% |
| Psa Healthcare Intermediate Holding LLC |
5% Or Greater Indirect Ownership Interest | Mar 19, 2015 | 100% |
| Jerrold Perchik |
Corporate Officer |
Apr 29, 2024 | |
| Pediatric Services of America LLC |
5% Or Greater Direct Ownership Interest | Aug 31, 2007 | 100% |
| Bcpe Eagle Investor, L.P. |
5% Or Greater Indirect Ownership Interest | Apr 29, 2021 | 41.83% |
| Jeffrey Shaner |
Corporate Officer |
Dec 1, 2015 | |
| Corporate Director |
Jan 1, 2023 | ||
| Pea Washington Holdings, LP |
5% Or Greater Indirect Ownership Interest | Apr 29, 2021 | 5.45% |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Aveanna Healthcare |
Home health agency | 5% Or Greater Indirect Ownership Interest (100%) | Sep 17, 2016 |
| Thrive Skilled Pediatric Care |
Home health agency | 5% Or Greater Indirect Ownership Interest (100%) | Jun 2, 2025 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2016 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Sep 26, 2020 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2016 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Sep 26, 2020 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130522000527 | PA | Part a Provider - Home Health Agency | 5991614760 | Practice locations: Olyphant, PA |
National Provider Directory
- Tax ID family
- Sleep Disorder Serv of
Locations
749 Northern Blvd
Ste B
South Abington Township, PA 18411
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes | ||
| Nursing Care Agency | 251J00000X |
Addresses
Primary practice location
1456 E Lackawanna St
Olyphant, PA 18447-2151
Mailing address
400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05040501 | Other | PA | HHA LICENSE |
Other names
- Aveanna Healthcare
Other providers in Olyphant, PA
- Nancy Naughton
- Alicia E Novak
- Melissa Olsommer
- Olyphant Community Ambulance Assoc and Rescue Squad
- Matthew Pasquale
- Physical Therapy Advantage, LLC
- Andrea Picozzo
- Dawn Marie Pilosi
- Plain Sight Opticians
- Joseph Gary Pruzinsky
All providers in Olyphant, PA · Home Health Agency in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.