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General NPI Number Information
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NPI Number | 1134178098
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Entity Type | Organization
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Legal Business Name | PEDIATRIC HOME CARE, INC.
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1120 NORTH MULLAN ROAD SUITE 206
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4074
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Country | US
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Telephone | 509-368-9252
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Fax | 509-368-9594
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Provider Business Mailing Address
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Address Line | 400 INTERSTATE NORTH PKWY SE STE 1600
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City | ATLANTA
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State | GA
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Zip | 30339-5047
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Country | US
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Telephone | 470-464-8000
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Fax | 770-248-8192
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Authorized Official
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Title or Position | CFO
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Name | MATTHEW BUCKHALTER
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Credential |
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Telephone | 470-464-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 00000344
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License Number State | WA
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