Provider Demographics
NPI:1346614526
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:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-940-0407
Mailing Address - Street 1:3180 ROUTE 611
Mailing Address - Street 2:SUITE 19
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18321-7824
Mailing Address - Country:US
Mailing Address - Phone:570-420-7939
Mailing Address - Fax:610-434-1179
Practice Address - Street 1:3180 ROUTE 611
Practice Address - Street 2:SUITE 19
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321-7824
Practice Address - Country:US
Practice Address - Phone:570-420-7939
Practice Address - Fax:610-434-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007625050090Medicaid
PA457042OtherLICENSE NUMBER