Healthcare Provider Details

I. General information

NPI: 1073084885
Provider Name (Legal Business Name): PYRAMID WALDEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44863 ST. ANDREW'S CHURCH RD
CALIFORNIA MD
20619
US

IV. Provider business mailing address

PO BOX 967
DUNCANSVILLE PA
16635-0967
US

V. Phone/Fax

Practice location:
  • Phone: 301-997-1300
  • Fax: 301-863-3368
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JASON HENDRICKS
Title or Position: CEO
Credential:
Phone: 814-940-0407