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NPI Code Detail

MEDICARE: AVALON HEALTH CARE - HIGHLAND HOUSE LLC

MEDICARE: AVALON HEALTH CARE - HIGHLAND HOUSE 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 Facility

General Provider Information

NPI Number : 1477903367
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVALON HEALTH CARE - HIGHLAND HOUSE 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 : 2201 NW HIGHLAND AVE
Second Line :
City : GRANTS PASS
State : OR
Zip : 97526-3365
Country : US
Telephone Number : 541-474-1901
Fax Number :
Authorized Official
Title or Position : CEO/CHAIRMAN
Name : CHARLES KIRTON
Credential :
Telephone Number : 801-596-8844
Provider Enumeration Date : 06/21/2016
Last Update Date : 08/17/2022

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