Provider Demographics
NPI:1306189766
Name:PYRAMIDION LLC
Entity Type:Organization
Organization Name:PYRAMIDION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-887-5280
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-0244
Mailing Address - Country:US
Mailing Address - Phone:508-887-5280
Mailing Address - Fax:
Practice Address - Street 1:2 GRAFTON CMN
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1534
Practice Address - Country:US
Practice Address - Phone:508-887-5280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA3715251K00000X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9773312Medicaid
MA9773312Medicaid