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NPI Code Detail

MEDICARE: AVALON CARE CENTER PULLMAN LLC

MEDICARE: AVALON CARE CENTER PULLMAN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH 1361WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114911484
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVALON CARE CENTER PULLMAN LLC
Provider Business Mailing Address
First Line : 206 N 2100 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84116-2927
Country : US
Telephone Number : 801-325-0153
Fax Number : 801-596-9001
Provider Business Practice Location Address
First Line : 1310 NW DEANE ST
Second Line :
City : PULLMAN
State : WA
Zip : 99163-3705
Country : US
Telephone Number : 509-332-1566
Fax Number : 509-332-0909
Authorized Official
Title or Position : CEO/CHAIRMAN
Name : CHARLES KIRTON
Credential :
Telephone Number : 801-596-8844
Provider Enumeration Date : 09/01/2005
Last Update Date : 08/17/2022

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Directions to “AVALON CARE CENTER PULLMAN LLC ” Practice Location

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