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General NPI Number Information
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NPI Number | 1194719450
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Entity Type | Organization
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Legal Business Name | AVALON CARE CENTER - ABERDEEN, LLC
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 920 ANDERSON DR
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City | ABERDEEN
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State | WA
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Zip | 98520-1007
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Country | US
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Telephone | 360-532-5122
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Fax | 360-532-9048
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Provider Business Mailing Address
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Address Line | 206 N 2100 W
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City | SALT LAKE CITY
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State | UT
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Zip | 84116-2927
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Country | US
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Telephone | 801-325-0153
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Fax | 801-596-9001
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Authorized Official
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Title or Position | CEO/CHAIRMAN
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Name | CHARLES KIRTON
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Credential |
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Telephone | 801-596-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1356
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License Number State | WA
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