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General NPI Number Information
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NPI Number | 1730173725
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Entity Type | Organization
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Legal Business Name | AVALON CARE CENTER-MADERA LLC
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 1700 HOWARD RD
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City | MADERA
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State | CA
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Zip | 93637-5131
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Country | US
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Telephone | 559-276-8765
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Fax | 559-673-0753
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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 | 84116-4740
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Country | US
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Telephone | 801-596-8844
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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 | 040000166
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License Number State | CA
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