Healthcare Provider Details

I. General information

NPI: 1023921996
Provider Name (Legal Business Name): AVALON CARE CENTER - SC VA SUMTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N WISE DR
SUMTER SC
29153-8580
US

IV. Provider business mailing address

915 N WISE DR
SUMTER SC
29153-8580
US

V. Phone/Fax

Practice location:
  • Phone: 803-965-9002
  • Fax: 803-965-5028
Mailing address:
  • Phone: 803-965-9002
  • Fax: 803-965-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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