Healthcare Provider Details

I. General information

NPI: 1477903367
Provider Name (Legal Business Name): AVALON HEALTH CARE - HIGHLAND HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 NW HIGHLAND AVE
GRANTS PASS OR
97526-3365
US

IV. Provider business mailing address

206 N 2100 W
SALT LAKE CITY UT
84116-4740
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-1901
  • Fax:
Mailing address:
  • Phone: 801-596-8844
  • Fax: 801-596-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES KIRTON
Title or Position: CEO/CHAIRMAN
Credential:
Phone: 801-596-8844