Provider Demographics
NPI:1790806115
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:814-941-0574
Practice Address - Street 1:4447 GIBSONIA RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-7998
Practice Address - Country:US
Practice Address - Phone:724-443-3220
Practice Address - Fax:724-443-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA707235261QR0405X, 3245S0500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10076250500010Medicaid
PA1007625050070Medicaid
PA1007625050081Medicaid
PA1007625050033Medicaid