Healthcare Provider Details

I. General information

NPI: 1588665236
Provider Name (Legal Business Name): AVALON CARE CENTER - BRIGHAM CITY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S 200 W
BRIGHAM CITY UT
84302-3333
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 435-723-5280
  • Fax: 435-723-0579
Mailing address:
  • Phone: 801-325-0153
  • Fax: 801-596-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2004-NCF-76
License Number StateUT

VIII. Authorized Official

Name: MS. FAYE LINCOLN
Title or Position: VP POLICY GOVERNMENT RELATIONS
Credential:
Phone: 801-325-0153