Avalon Care Center-Othello LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1359 Issued in WA

Legal business name

AVALON CARE CENTER-OTHELLO LLC

Practice address

495 N 13TH Ave
Othello, WA 99344-1215

Phone

(509) 488-9609

Fax

(509) 488-6191

NPI assigned

Sep 1, 2005

Last updated

Aug 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Kirton

Title

Ceo/Chairman

Phone

(801) 596-8844

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1528052891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N 2100 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841162927",
            "telephone_number": "801-325-0153",
            "fax_number": "801-596-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 N 13TH AVE",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441215",
            "telephone_number": "509-488-9609",
            "fax_number": "509-488-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON CARE CENTER-OTHELLO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "KIRTON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CEO/CHAIRMAN",
        "authorized_official_telephone_number": "801-596-8844"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4113593",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Alvarez, PA-C, PHARMD
• Natalie Andersen, RDH
• Maria Guadalupe Arceno
• Trent Z Armstrong, ARNP
• Alaa Atfeh, M.D.
• Fatima Zahraa Bahar
• Caitlin Ballard
• Sarah Bannon, ARNP
• Margarita Barrera
• Gabriel W Barrio, M.D.

• Skilled Nursing Facility in Othello, WA
• Providers in Othello, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.