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Organization
AVALON CARE CENTER-OTHELLO LLC
Active
Organization
AVALON CARE CENTER-OTHELLO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES KIRTON (CEO/CHAIRMAN)
(801) 596-8844
Entity
Organization
Contact information
Practice address
495 N 13TH AVE, OTHELLO, WA 99344-1215
(509) 488-9609
(509) 488-6191
Mailing address
206 N 2100 W, SALT LAKE CITY, UT 84116-2927
(801) 325-0153
(801) 596-9001
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1359
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4113593
—
WA
Enumeration date
09/01/2005
Last updated
08/17/2022
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