Provider Demographics
NPI:1144384751
Name:AVOLIO CORPORATION
Entity type:Organization
Organization Name:AVOLIO CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:724-523-6488
Mailing Address - Street 1:621 N. 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-1750
Mailing Address - Country:US
Mailing Address - Phone:724-523-6488
Mailing Address - Fax:724-523-6680
Practice Address - Street 1:621 N. 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-1750
Practice Address - Country:US
Practice Address - Phone:724-523-6488
Practice Address - Fax:724-523-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN072007L164W00000X
261QH0100X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000R598OtherUPMC
PA1045130OtherAETNA HEALTH MANAGEMENT,
PA78676OtherHEALTH ASSURANCE
PA1045130OtherAETNA HEALTH MANAGEMENT,