Healthcare Provider Details

I. General information

NPI: 1720037856
Provider Name (Legal Business Name): AVALON CARE CENTER - BOUNTIFUL 350 SOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S 400 E
BOUNTIFUL UT
84010-4932
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-397-4900
  • Fax:
Mailing address:
  • Phone: 801-325-0153
  • Fax: 801-596-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: FAYE LINCOLN
Title or Position: V.P. POLICY/GOVERNMENT RELATIONS
Credential:
Phone: 801-325-0153