1790806115 NPI number — PYRAMID HEALTHCARE INC

Table of content: (NPI 1790806115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790806115 NPI number — PYRAMID HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PYRAMID HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790806115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1894 PLANK RD
Provider Second Line Business Mailing Address:
P.O. BOX 967
Provider Business Mailing Address City Name:
DUNCANSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16635-8380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-940-0407
Provider Business Mailing Address Fax Number:
814-941-0574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4447 GIBSONIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIBSONIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15044-7998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-443-3220
Provider Business Practice Location Address Fax Number:
724-443-3771
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
814-940-0407

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  707235 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3245S0500X , with the licence number: 707235 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10076250500010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007625050070 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007625050081 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007625050033 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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