Healthcare Provider Details

I. General information

NPI: 1659988525
Provider Name (Legal Business Name): PYRAMID HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHESAPEAKE AVE
NEWPORT NEWS VA
23607-6038
US

IV. Provider business mailing address

PO BOX 967
DUNCANSVILLE PA
16635-0967
US

V. Phone/Fax

Practice location:
  • Phone: 757-817-7570
  • Fax:
Mailing address:
  • Phone: 814-947-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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