Provider Demographics
NPI:1295226512
Name:PYRAMID PSYCHIATRIC CARE, LLC
Entity Type:Organization
Organization Name:PYRAMID PSYCHIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-632-2248
Mailing Address - Street 1:2475 UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-5099
Mailing Address - Country:US
Mailing Address - Phone:920-632-2248
Mailing Address - Fax:920-351-4826
Practice Address - Street 1:2475 UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-5099
Practice Address - Country:US
Practice Address - Phone:920-632-2248
Practice Address - Fax:920-351-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty