| Aveanna Healthcare | |
|
77 Brant Ave Suite 320 Clark NJ 07066-1560 | |
| (973) 510-0120 | |
| (973) 928-0254 |
| Full Name | Aveanna Healthcare |
|---|---|
| Speciality | Home Health |
| Location | 77 Brant Ave, Clark, New Jersey |
| Authorized Official Name and Position | Shannon Drake (CHIEF LEGAL OFFICER) |
| Authorized Official Contact | 4704648000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aveanna Healthcare 400 Interstate North Pkwy Se Ste 1600 Atlanta GA 30339-5047 Ph: (470) 464-8000 | Aveanna Healthcare 77 Brant Ave Suite 320 Clark NJ 07066-1560 Ph: (973) 510-0120 |
| NPI Number | 1841690070 |
|---|---|
| Provider Enumeration Date | 08/25/2014 |
| Last Update Date | 09/21/2023 |
| Certification Date | 09/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841690070 | NPI | - | NPPES |
| 0274666 | Medicaid | NJ | |
| 0252021 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | HP0120800 (New Jersey) | Secondary |
| 251E00000X | Home Health | HP0120800 (New Jersey) | Primary |
| 251J00000X | Nursing Care | HP0120800 (New Jersey) | Secondary |
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