MEDICARE: PEDIATRIC HOME CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	00000344	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134178098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC HOME CARE, INC.

Provider Business Mailing Address
First Line	:	400 INTERSTATE NORTH PKWY SE STE 1600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5047
Country	:	US
Telephone Number	:	470-464-8000
Fax Number	:	770-248-8192

Provider Business Practice Location Address
First Line	:	1120 NORTH MULLAN ROAD
Second Line	:	SUITE 206
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4074
Country	:	US
Telephone Number	:	509-368-9252
Fax Number	:	509-368-9594

Authorized Official
Title or Position	:	CFO
Name	:	MATTHEW BUCKHALTER
Credential	:
Telephone Number	:	470-464-8000

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	01/27/2025

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