Provider Demographics
NPI:1942496310
Name:PYRAMID RESOURCES ENTERPRISES, INC.
Entity Type:Organization
Organization Name:PYRAMID RESOURCES ENTERPRISES, INC.
Other - Org Name:POSITIVE LIVING TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-827-2701
Mailing Address - Street 1:3330 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6246
Mailing Address - Country:US
Mailing Address - Phone:504-827-2701
Mailing Address - Fax:504-827-2715
Practice Address - Street 1:3330 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6246
Practice Address - Country:US
Practice Address - Phone:504-827-2701
Practice Address - Fax:504-827-2715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PYRAMID RESOURCES ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19-4644Medicare UPIN