NPIMap

Organization Active NPI

Pediatric Services of America, LLC

Doing business as Aveanna Healthcare

  • Nursing Care Agency
  • Vancouver, WA
National Provider Identifier
1699707968
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
License
IS-423 Issued in WA
Legal business name
PEDIATRIC SERVICES OF AMERICA, LLC
Doing business as
Aveanna Healthcare
Practice address
9105 NE Highway 99
Ste 202, Building a
Vancouver, WA 98665-8961
Phone
(360) 639-7595
Fax
(360) 693-7262
NPI assigned
Jul 7, 2006
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU
Nursing Care Agency 251J00000X IS-423 WA Primary

Addresses

Primary practice location

9105 NE Highway 99
Ste 202, Building a
Vancouver, WA 98665-8961

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
9046731MedicaidWA
9049651MedicaidWA

Other names 1

  • Aveanna Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110617000120 WA Part A Provider - Home Health Agency 5991614760 Practice locations: Vancouver, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699707968. Details of each certification follow.

Home health agency certification: CCN 507095

Legal name
PEDIATRIC SERVICES OF AMERICA, LLC
Doing business as
AVEANNA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 23, 1993
Last certification
May 7, 2012
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Dec 20, 2020 in GA
Enrollment address
9105 NE Highway 99
Ste 202
Vancouver, WA 98665-8974
HHA Branch

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Care Compare: Home health agency

Medicare Care Compare
Listed as
Psa Healthcare CertifiedCCN 507095 · All quality measures
Ownership
Proprietary
Certified
Jun 23, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Services 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

9105 NE Highway 99
Ste 202
Vancouver, WA 98665
Phone (360) 639-7595

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Angie Garber Individual W-2 Managing EmployeeAd; Sep 30, 2021
J.H. Whitney VII LP Organization, New Canaan, CT For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 19, 2015 16.09%
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 8.04%
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%
Pediatric Services Holding LLC Organization, Atlanta, GA Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 31, 2007 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 For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2023 6.34%
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 5.35%
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 19, 2015 7.5%
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 35.54%
Psa Healthcare Intermediate Holding LLC Organization, Atlanta, GA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 19, 2015 100%
Jerrold Perchik Individual Corporate OfficerSecretary Apr 29, 2024
Pediatric Services of America LLC Organization, Atlanta, GA Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 31, 2007 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 41.83%
Jeffrey Shaner Individual Corporate OfficerCeo Dec 1, 2015
Corporate DirectorCeo Jan 1, 2023
Pea Washington Holdings, LP Organization, Jersey City, NJ For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 5.45%

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aveanna HealthcareEnglewood, CO, CCN 067192 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Sep 17, 2016
Thrive Skilled Pediatric CareScottsdale, AZ, CCN 037286 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jun 2, 2025
Aveanna HealthcareErie, PA, CCN 397310 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016
Aveanna HealthcareLoveland, CO, CCN 067477 Home health agency 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2020
Aveanna HealthcareWexford, PA, CCN 397278 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016
Aveanna HealthcareWestminster, CO, CCN 067496 Home health agency 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2020
Aveanna HealthcareDu Bois, PA, CCN 398190 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 122

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

  • 5 Star Home Health Services, LLC

    dba Aveanna Home Health

    • Home Health Agency
    • Orlando, FL
    • NPI 1376584730

    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
  • 5 Star Home Health Services, LLC

    dba Aveanna Home Health

    • Home Health Agency
    • Gainesville, FL
    • NPI 1518182773

    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
    • 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
    • Phoenix, AZ
    • NPI 1013156470

    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
  • Andventure, LLC

    dba Aveanna Healthcare

    • Home Health Agency
    • Springfield, MA
    • NPI 1881833259

    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
  • Comfort Care Coastal Home Health, LLC

    dba Aveanna Home Health

    • Home Health Agency
    • Foley, AL
    • NPI 1740653047

    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
View all 122

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1699707968",
    "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": "9105 NE HIGHWAY 99",
            "address_2": "STE 202, BUILDING A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658961",
            "telephone_number": "360-639-7595",
            "fax_number": "360-693-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "WA",
            "license": "IS-423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9046731",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9049651",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.