NPIMap

Organization Active NPI

Pediatria Healthcare, LLC

Doing business as Aveanna Healthcare

  • Home Health Agency
  • Wilkes Barre, PA
National Provider Identifier
1508168170
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
04250501 Issued in PA
Legal business name
PEDIATRIA HEALTHCARE, LLC
Doing business as
Aveanna Healthcare
Practice address
1167 N Washington St Ste E
Wilkes Barre, PA 18705-1856
Phone
(570) 371-5606
NPI assigned
Dec 2, 2010
Last updated
Jan 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 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 04250501 PA Primary

Addresses

Primary practice location

1167 N Washington St Ste E
Wilkes Barre, PA 18705-1856

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
04250501OtherPAHOME HEALTH AGENCY LICENSE
101299280 0009MedicaidPA

Other names 1

  • Aveanna Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110210000873 PA Part A Provider - Home Health Agency 4082791074 Practice locations: Wilkes Barre, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508168170. Details of each certification follow.

Home health agency certification: CCN 398157

Legal name
PEDIATRIA HEALTHCARE, LLC
Doing business as
AVEANNA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 17, 2011
Last certification
Aug 15, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jan 25, 2006 in DE
Enrollment address
1167 N Washington St
Ste E
Wilkes Barre, PA 18705-1856

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Aveanna HealthcareCCN 398157 · All quality measures
Ownership
Proprietary
Certified
Mar 17, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide

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
39D2018408Aveanna Healthcare1167 North Washington Street, Suite E, Wilkes Barre, PA 18705Certificate of waiverJan 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pediatria Healthcare LLC26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1167 N Washington St
Ste E
Wilkes Barre, PA 18705
Phone (570) 371-5606

Ownership & related parties

All disclosed owners & managing parties 18

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 Mar 16, 2017 16.36%
Psa Healthcare Investment Holding LLC Organization, New Canaan, CT LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 8.17%
Aveanna Healthcare LLC Organization, Atlanta, GA LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 100%
Aveanna Healthcare Intermediate Holdings LLC Organization, Atlanta, GA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 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 Mar 16, 2017 100%
Nut Tree Master Fund LP Organization, New York, NY Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2023 6.43%
Matthew Buckhalter Individual Corporate OfficerCfo Jul 7, 2023
Corporate DirectorCfo Jul 7, 2023
Bcip Associates IV US L.P. Organization, Boston, MA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 5.43%
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 Mar 16, 2017 7.62%
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 Mar 16, 2017 36.04%
Jerrold Perchik Individual Corporate OfficerSecretary Apr 29, 2024
David Kaminski Individual W-2 Managing EmployeeAd; Aug 21, 2023
Epic Health Services, Inc. Organization, Atlanta, GA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 16, 2017 100%
Epic Acquisition, Inc. Organization, Atlanta, GA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 100%
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 42.42%
Jeffrey Shaner Individual Corporate OfficerCeo Mar 16, 2017
Corporate DirectorCeo Jan 1, 2023
Pea Washington Holdings, LP Organization, George Town For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 5.54%

Facilities with the same owner 122

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

  • Andventure, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Chambersburg, PA
    • NPI 1013150275

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Lancaster, PA
    • NPI 1093788002

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • State College, PA
    • NPI 1760621122

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Angel's Touch Home Care, LLC

    dba Aveanna Home Health

    • Home Health Agency
    • West Pittston, PA
    • NPI 1376762237

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc

    dba Aveanna Healthcare

    • Home Health Agency
    • Du Bois, PA
    • NPI 1811279540

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc.

    dba Aveanna Healthcare

    • Home Health Agency
    • Wexford, PA
    • NPI 1407809114

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc.

    dba Aveanna Healthcare

    • Home Health Agency
    • Erie, PA
    • NPI 1912101726

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Epic Health Services (PA), LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • East Norriton, PA
    • NPI 1033570445

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Epic Acquisition, Inc., Epic Health Services, Inc., Hamilton Lan

    CMS ownership
  • Epic Health Services (PA), LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Bala Cynwyd, PA
    • NPI 1326058223

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Epic Acquisition, Inc., Epic Health Services, Inc., Hamilton Lan

    CMS ownership
  • Loving Care Agency, Inc.

    dba Aveanna Healthcare

    • Home Health Agency
    • East Stroudsburg, PA
    • NPI 1245368927

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Epic Acquisition, Inc., Epic Health Services, Inc., Hamilton Lan

    CMS ownership
  • Loving Care Agency, Inc.

    dba Aveanna Healthcare

    • Home Health Agency
    • Allentown, PA
    • NPI 1558490169

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Epic Acquisition, Inc., Epic Health Services, Inc., Hamilton Lan

    CMS ownership
  • Loving Care Agency, Inc.

    dba Aveanna Healthcare

    • Home Health Agency
    • Trevose, PA
    • NPI 1912035585

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Epic Acquisition, Inc., Epic Health Services, Inc., Hamilton Lan

    CMS ownership
View all 122

NPI Registry JSON

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

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1508168170",
    "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": "1167 N WASHINGTON ST STE E",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187051856",
            "telephone_number": "570-371-5606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-02",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "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": "PA",
            "license": "04250501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH AGENCY LICENSE",
            "identifier": "04250501",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101299280 0009",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.