NPIMap

Organization Active NPI

Pediatric Services of America, LLC

Doing business as Aveanna Healthcare

  • Nursing Care Agency
  • Lakewood, WA
National Provider Identifier
1871761411
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
Legal business name
PEDIATRIC SERVICES OF AMERICA, LLC
Doing business as
Aveanna Healthcare
Practice address
7602 Bridgeport Way W
Suite 2B
Lakewood, WA 98499-2415
Phone
(253) 912-4860
Fax
(253) 912-4862
NPI assigned
Feb 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 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
(470) 464-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X Primary

Addresses

Primary practice location

7602 Bridgeport Way W
Suite 2B
Lakewood, WA 98499-2415

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
IHS.FS.00000423OtherWAWASHINGTON STATE DEPT OF HEALTH

Other names 1

  • Aveanna 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

7602 Bridgeport Way W
Ste 2B
Lakewood, WA 98499
Phone (253) 912-4860

NPI Registry JSON

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

{
    "created_epoch": "1203292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1871761411",
    "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": "7602 BRIDGEPORT WAY W",
            "address_2": "SUITE 2B",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992415",
            "telephone_number": "253-912-4860",
            "fax_number": "253-912-4862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-18",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "WHITESIDE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "AVP REGULATORY LICENSING",
        "authorized_official_telephone_number": "470-464-8000"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPT OF HEALTH",
            "identifier": "IHS.FS.00000423",
            "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 Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.