MEDICARE: PYRAMID TOTAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1891571998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PYRAMID TOTAL CARE LLC

Provider Business Mailing Address
First Line	:	1601 INDUSTRIAL BLVD STE 3031
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-2602
Country	:	US
Telephone Number	:	832-380-8304
Fax Number	:	832-380-8613

Provider Business Practice Location Address
First Line	:	1601 INDUSTRIAL BLVD STE 3031
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-2602
Country	:	US
Telephone Number	:	832-380-8304
Fax Number	:	832-380-8613

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	OLUFOLAKE SHODEINDE
Credential	:
Telephone Number	:	832-380-8304

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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