Avalon Care Center - Portland LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

AVALON CARE CENTER - PORTLAND LLC

Doing business as

Avalon Care Center - Portland
Avalon Residential Care Center Portland

Practice address

12640 SE Bush St
Portland, OR 97236-3423

Phone

(503) 761-6621

NPI assigned

Feb 8, 2022

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 names 2

• Avalon Care Center - Portland Doing business as
• Avalon Residential Care Center Portland Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1538813670",
    "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": "841164740",
            "telephone_number": "801-596-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12640 SE BUSH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363423",
            "telephone_number": "503-761-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON CARE CENTER - PORTLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-08",
        "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": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avalon Care Center - Portland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avalon Care Center - Portland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avalon Residential Care Center Portland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nursing Facility/Intermediate Care Facility in Portland, OR
• Providers in Portland, OR by specialty
• Nursing Facility/Intermediate Care Facility in Oregon

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.