Avalon Care Center - Federal Way LLC
Organization Active NPI Skilled Nursing Facility · Federal Way, WA
NPI 1902890262 · NPPES record last updated Mar 27, 2025
Key facts
- NPI
- 1902890262
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 1355 (WA)
- Legal business name
- AVALON CARE CENTER - FEDERAL WAY LLC
- Practice address
- 135 S 336TH St
Federal Way, WA 98003-6350 - Phone
- (253) 835-7453
- Fax
- (253) 835-3903
- NPI assigned
- Sep 1, 2005
- Organization subpart
- No
Authorized official
- Name
- Charles Kirton
- Title
- Ceo/Chairman
- Phone
- (801) 596-8844
Owners & managing parties with NPI records 1
-
Atique Ahmad, M.D.
Facilities with the same owner 17
Practitioners 1
-
Atique Ahmad, M.D.
Affiliated clinicians 1
-
Atique Ahmad, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Avalon Care Center Federal Way, L.L.C.
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Aug 2, 2002
- Medicare certification status
- Active
- Certified beds
- 120 · 109.5 residents per day on average
- Chain
- Avalon Health Care
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D0995915 | Avalon Care Center Federal Way | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Skilled nursing facility certification: CCN 505510
- Legal name
- AVALON CARE CENTER - FEDERAL WAY, LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 2, 2002
- Last certification
- Jul 24, 2024
- Beds
- 120
- Ownership / control type
- Corporation
- Multi-facility organization
- Avalon
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 26, 2003 in WA
- Enrollment address
- 135 S 336TH St
Federal Way, WA 98003-6350 - Nursing home name
- AVALON CARE CENTER FEDERAL WAY, L.L.C.
- Affiliated entity
- AVALON HEALTH CARE
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Atique Ahmad |
Operational/Managerial Control | Mar 26, 2025 | |
| Adp of the SNF | Mar 26, 2025 | ||
| The Byron a Kirton Individual TR |
5% Or Greater Indirect Ownership Interest | Oct 1, 2025 | 26.67% |
| Robert D Woltil |
Corporate Director |
May 23, 2012 | |
| Managing Control - Governing Body |
May 23, 2012 | ||
| |
Adp of the SNF | Nov 30, 2004 | |
| Avalon Health Care Management Inc |
Operational/Managerial Control | Dec 1, 2003 | |
| Adp of the SNF | Apr 9, 2025 | ||
| Samantha Wachowski |
Operational/Managerial Control | Dec 29, 2022 | |
| Adp of the SNF | Dec 29, 2022 | ||
| Hyrum a Kirton Individual TR |
5% Or Greater Indirect Ownership Interest | Oct 1, 2025 | 33.33% |
| Spencer Kirton |
5% Or Greater Indirect Ownership Interest | Oct 1, 2025 | 33.33% |
| Corporate Director |
Aug 27, 2024 | ||
| Managing Control - Governing Body |
Aug 27, 2024 | ||
| Nicole Smith |
Corporate Officer |
Mar 1, 2023 | |
| Operational/Managerial Control | Mar 1, 2023 | ||
| Adp of the SNF | Mar 1, 2023 | ||
| Avalon Health Care Inc |
5% Or Greater Indirect Ownership Interest | Dec 1, 2003 | 100% |
| Operational/Managerial Control | Dec 1, 2003 | ||
| Adp of the SNF | May 14, 2025 | ||
| Byron a Kirton |
5% Or Greater Indirect Ownership Interest | Oct 1, 2025 | 33.33% |
| Corporate Director |
Aug 27, 2024 | ||
| Managing Control - Governing Body |
Aug 27, 2024 | ||
| Avalon of Washington LLC |
5% Or Greater Direct Ownership Interest | Jul 20, 2004 | 100% |
| Inga Stoa |
Operational/Managerial Control | Sep 10, 2025 | |
| Adp of the SNF | Sep 10, 2025 | ||
| K-Team LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2025 | 6.67% |
| Avalon Care LLC |
5% Or Greater Indirect Ownership Interest | Aug 1, 2004 | 100% |
| Hyrum Kirton |
5% Or Greater Indirect Ownership Interest | Oct 1, 2025 | 33.33% |
| Corporate Officer |
Mar 29, 2022 | ||
| Corporate Director |
Aug 27, 2024 | ||
| Operational/Managerial Control | Mar 29, 2022 | ||
| Managing Control - Governing Body |
Aug 27, 2024 | ||
| Adp of the SNF | Mar 29, 2022 | ||
| Spencer K Kirton Individual TR |
5% Or Greater Indirect Ownership Interest | Oct 1, 2025 | 33.33% |
| Maria Borisevich |
Corporate Officer |
Jan 8, 2024 | |
| Operational/Managerial Control | Jan 8, 2024 | ||
| Adp of the SNF | Jan 8, 2024 | ||
| David E Dangerfield |
Corporate Director |
Apr 5, 2007 | |
| Managing Control - Governing Body |
Apr 5, 2007 | ||
| Avalon Holding Inc |
5% Or Greater Indirect Ownership Interest | Dec 1, 2003 | 100% |
| Alan B Hash |
Corporate Officer |
Aug 15, 2017 | |
| Operational/Managerial Control | Aug 15, 2017 | ||
| Adp of the SNF | Aug 15, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030920000011 | WA | Part a Provider - Skilled Nursing Facility | 7315858495 | Practice locations: Federal Way, WA |
National Provider Directory
Locations
135 S 336th St
Federal Way, WA 98003
Phone (253) 835-7433
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1355 | WA | Yes |
Addresses
Primary practice location
135 S 336TH St
Federal Way, WA 98003-6350
Mailing address
206 N 2100 W
Salt Lake City, UT 84116-2927
Phone (801) 325-0153
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4113551 | Medicaid | WA |
NPI Registry JSON
{
"created_epoch": "1125532800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1743033600000",
"number": "1902890262",
"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": "135 S 336TH ST",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980036350",
"telephone_number": "253-835-7453",
"fax_number": "253-835-3903"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVALON CARE CENTER - FEDERAL WAY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-01",
"last_updated": "2025-03-27",
"certification_date": "2025-03-27",
"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": "1355",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4113551",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
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All providers in Federal Way, 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 Mar 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.