MEDICARE: AVALON CARE CENTER - SPOKANE 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
1	3140N1450X	Pediatric Skilled Nursing Facility
2	314000000X	Skilled Nursing Facility	NH 1358	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1992799266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALON CARE CENTER - SPOKANE 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	:	9827 N NEVADA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-3407
Country	:	US
Telephone Number	:	509-468-7000
Fax Number	:	509-468-1659

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	:	04/14/2025

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