Avalon Care Center-Othello LLC
Organization Active NPI Skilled Nursing Facility · Othello, WA
NPI 1528052891 · NPPES record last updated Aug 17, 2022
Key facts
- NPI
- 1528052891
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 1359 (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
- Organization subpart
- No
Authorized official
- Name
- Charles Kirton
- Title
- Ceo/Chairman
- Phone
- (801) 596-8844
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1359 | WA | Yes |
Addresses
Primary practice location
495 N 13TH Ave
Othello, WA 99344-1215
Mailing address
206 N 2100 W
Salt Lake City, UT 84116-2927
Phone (801) 325-0153
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4113593 | Medicaid | WA |
Other providers in Othello, WA
- Melissa Alvarez
- Natalie Andersen
- Maria Guadalupe Arceno
- Trent Z Armstrong
- Alaa Atfeh
- Fatima Zahraa Bahar
- Caitlin Ballard
- Sarah Bannon
- Margarita Barrera
- Gabriel W Barrio
All providers in Othello, WA · Skilled Nursing Facility in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.