Provider Demographics
NPI:1215208301
Name:PYRAMID HEALTHCARE INC.
Entity Type:Organization
Organization Name:PYRAMID HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-940-0407
Mailing Address - Street 1:1894 PLANK RD
Mailing Address - Street 2:P.O. BOX 967
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8380
Mailing Address - Country:US
Mailing Address - Phone:814-940-0407
Mailing Address - Fax:814-946-1402
Practice Address - Street 1:124 CHAMBERS HILL DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-7301
Practice Address - Country:US
Practice Address - Phone:717-261-9100
Practice Address - Fax:717-261-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA287051261Q00000X, 261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007625050018Medicaid
PA1007625050015Medicaid
PA1007625050019Medicaid
PA287051OtherSTATE LICENSE