Healthcare Provider Details

I. General information

NPI: 1194719450
Provider Name (Legal Business Name): AVALON CARE CENTER - ABERDEEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 ANDERSON DR
ABERDEEN WA
98520-1007
US

IV. Provider business mailing address

206 N 2100 W
SALT LAKE CITY UT
84116-2927
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-5122
  • Fax: 360-532-9048
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 Number1356
License Number StateWA

VIII. Authorized Official

Name: CHARLES KIRTON
Title or Position: CEO/CHAIRMAN
Credential:
Phone: 801-596-8844