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NPI Code Detail

MEDICARE: AVALON VALLEY CARE CENTER LLC

MEDICARE: AVALON VALLEY CARE CENTER 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 Facility2005-NCF-55UT

General Provider Information

NPI Number : 1700870896
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVALON VALLEY CARE CENTER 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 : 801-325-0153
Fax Number : 801-596-9001
Provider Business Practice Location Address
First Line : 2472 S 300 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-2895
Country : US
Telephone Number : 801-466-2211
Fax Number : 801-486-1154
Authorized Official
Title or Position : VP, POLICY/GOVERNMENT RELATIONS
Name : FAYE LINCOLN
Credential :
Telephone Number : 801-325-0153
Provider Enumeration Date : 09/06/2005
Last Update Date : 08/29/2013

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Directions to “AVALON VALLEY CARE CENTER LLC ” Practice Location

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