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NPI Code Detail

MEDICARE: AVALON CARE CENTER-SAN ANDREAS LLC

MEDICARE: AVALON CARE CENTER-SAN ANDREAS 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 Facility030000135CA

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 : 1215921242
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVALON CARE CENTER-SAN ANDREAS LLC
Provider Business Mailing Address
First Line : 206 N 2100 W
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84116-4740
Country : US
Telephone Number : 801-596-8844
Fax Number : 801-596-9001
Provider Business Practice Location Address
First Line : 900 MOUNTAIN RANCH RD
Second Line :
City : SAN ANDREAS
State : CA
Zip : 95249-9713
Country : US
Telephone Number : 209-754-3823
Fax Number : 209-754-5621
Authorized Official
Title or Position : CEO/CHAIRMAN
Name : CHARLES KIRTON
Credential :
Telephone Number : 801-596-8844
Provider Enumeration Date : 09/06/2005
Last Update Date : 08/17/2022

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Directions to “AVALON CARE CENTER-SAN ANDREAS LLC ” Practice Location

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