AVEANNA HEALTHCARE
Complete NPI Record 1104848134
Home Health in Shelton, CT
Active since July 25, 2006CLIA Certified · 2 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Aveanna Healthcare (NPI 1104848134), a home health organization in Shelton, CT. All 40 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1104848134 Field 1/40
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/40
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/40
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: PEDIATRIC SERVICES OF AMERICA, LLC Field 4/40
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: AVEANNA HEALTHCARE Field 5/40
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/40
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 400 INTERSTATE NORTH PKWY SE STE 1600 Field 7/40
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: ATLANTA Field 8/40
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: GA Field 9/40
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 303395047 Field 10/40
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/40
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4704648000 Field 12/40
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 7702488192 Field 13/40
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1000 BRIDGEPORT AVE STE 309 Field 14/40
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: SHELTON Field 15/40
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: CT Field 16/40
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 064844660 Field 17/40
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/40
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 2033811530 Field 19/40
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 2033811535 Field 20/40
- The fax number associated with the location address of the provider being identified.
- NPI Deactivation Date: 3/31/2021 Field 23/40
- The date that the provider's NPI was deactivated in the NPS.
- NPI Reactivation Date: 4/20/2021 Field 24/40
- The date that the provider's NPI was reactivated in the NPS.
- Authorized Official Last Name: SPEER Field 25/40
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: KATE Field 26/40
- The first name of the authorized official.
- Authorized Official Title or Position: AVP, REGULATORY LICENSING Field 27/40
- The title or position of the authorized official.
- Authorized Official Telephone Number: 9523583278 Field 28/40
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 251E00000X Field 29/40
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: C9612701 Field 30/40
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: CT Field 31/40
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 32/40
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 004217304 Field 33/40
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 34/40
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: CT Field 35/40
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier 2: 4187953 Field 36/40
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 2: 05 Field 37/40
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 2: CT Field 38/40
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Organization Subpart: N Field 39/40
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Secondary Practice Locations 2
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
146 New Britain Ave Ste 1
Location 1/2Plainville, CT 06062-2077 · Phone (860) 747-3306 · Fax (860) 747-4064
55 Main St Unit 350
Location 2/2Norwich, CT 06360-5760 · Phone (860) 383-1909 · Fax (860) 383-1914
Other Provider Identifiers 2
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
004217304 Medicaid
Identifier 1/2State: CT
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
4187953 Medicaid
Identifier 2/2State: CT
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
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