Healthcare Provider Details

I. General information

NPI: 1790531010
Provider Name (Legal Business Name): AVALON CARE CENTER - SCAPPOOSE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33910 E COLUMBIA AVE
SCAPPOOSE OR
97056-3309
US

IV. Provider business mailing address

206 N 2100 W STE 100
SALT LAKE CITY UT
84116-4741
US

V. Phone/Fax

Practice location:
  • Phone: 503-543-7131
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HYRUM KIRTON
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 801-596-8844