# AVALON CARE CENTER-OTHELLO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528052891
- **Authorized official:** CHARLES KIRTON (CEO/CHAIRMAN)
- **Authorized official phone:** (801) 596-8844

## Contact information

- **Practice address:** 495 N 13TH AVE, OTHELLO, WA 99344-1215
- **Practice address phone:** (509) 488-9609
- **Practice address fax:** (509) 488-6191
- **Mailing address:** 206 N 2100 W, SALT LAKE CITY, UT 84116-2927
- **Mailing address phone:** (801) 325-0153
- **Mailing address fax:** (801) 596-9001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1359 | WA | Yes |

## Other

- **Enumeration date:** 09/01/2005
- **Last updated:** 08/17/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4113593 | — | WA |