# AVALON CARE CENTER-SAN ANDREAS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avalon Health Care-San Andreas
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215921242
- **Authorized official:** CHARLES KIRTON (CEO/CHAIRMAN)
- **Authorized official phone:** (801) 596-8844

## Contact information

- **Practice address:** 900 MOUNTAIN RANCH RD, SAN ANDREAS, CA 95249-9713
- **Practice address phone:** (209) 754-3823
- **Practice address fax:** (209) 754-5621
- **Mailing address:** 206 N 2100 W, SALT LAKE CITY, UT 84116-4740
- **Mailing address phone:** (801) 596-8844
- **Mailing address fax:** (801) 596-9001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 030000135 | CA | Yes |

## Other

- **Enumeration date:** 09/06/2005
- **Last updated:** 08/17/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR061321I | — | CA |