Healthcare Provider Details

I. General information

NPI: 1205177722
Provider Name (Legal Business Name): AVALON CARE CENTER - VA PAYSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 NORTH MAIN STREET
PAYSON UT
84651
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-596-8844
  • Fax: 801-596-9001
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: CHARLES KIRTON
Title or Position: CEO
Credential:
Phone: 801-596-8844