10D2087650 CLIA NUMBER - PEDIATRIA HEALTHCARE LLC DBA AVEANNA HEALTHCARE

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Laboratory Demographics

CLIA Number: 10D2087650

Facility Name: PEDIATRIA HEALTHCARE LLC DBA AVEANNA HEALTHCARE

Facility Address:
724 BOWING OAK DR
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 962-3695

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1790181568

Taxonomy: 261QM3000X - Clinic/Center
An entity, facility, or distinct part of a facility specially equipped and staffed to provide care for medically fragile children with varied and complex care needs (e.g., enteral or parental feeding, ostomy care, respiratory/ventilator care, medications and therapies, etc.).

CLIA Record

Field Name	Field Value
CLIA Number	10D2087650
LAB Type	Home Health Agency
Facility Name	PEDIATRIA HEALTHCARE LLC DBA AVEANNA HEALTHCARE
Street	724 BOWING OAK DR
City	BRANDON
State	FL
ZIP	33511
Phone	813 962-3695
CertificateType	4
CertificateEffectiveDate	12/2/2022
CertificateExpirationDate	12/1/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024