Provider Demographics
NPI:1689078321
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:
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 1:1230 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-7502
Mailing Address - Country:US
Mailing Address - Phone:215-244-7607
Mailing Address - Fax:215-788-8479
Practice Address - Street 1:1230 VETERANS HWY
Practice Address - Street 2:SUITE A-8
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-7502
Practice Address - Country:US
Practice Address - Phone:215-244-7607
Practice Address - Fax:215-788-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA097102261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10076250500088Medicaid
PA097102OtherLICENSE NUMBER
PA1007625050086Medicaid