Healthcare Provider Details

I. General information

NPI: 1992799266
Provider Name (Legal Business Name): AVALON CARE CENTER - SPOKANE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9827 N NEVADA ST
SPOKANE WA
99218-3407
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 509-468-7000
  • Fax: 509-468-1659
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 NumberNH 1358
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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