1144384751 NPI number — AVOLIO CORP

Table of content: (NPI 1144384751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144384751 NPI number — AVOLIO CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVOLIO CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARLINGTON MEDICAL AND NUTRITION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144384751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
372 N 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-523-6488
Provider Business Mailing Address Fax Number:
724-523-6680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
372 N 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEANNETTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15644-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-523-6488
Provider Business Practice Location Address Fax Number:
724-523-6680
Provider Enumeration Date:
12/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
MARYJO
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSE OWNER
Authorized Official Telephone Number:
724-523-6488

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 164W00000X , with the licence number: PN072007L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1045130 . This is a "AETNA HEALTH MANAGEMENT," identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 78676 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".