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General NPI Number Information
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NPI Number | 1124450069
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Entity Type | Organization
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Legal Business Name | PYRAMID HEALTHCARE INC.
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 420 SUPREME CT
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City | EAST STROUDSBURG
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State | PA
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Zip | 18302-6800
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Country | US
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Telephone | 814-940-0407
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Fax |
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Provider Business Mailing Address
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Address Line | 1894 PLANK RD PO BOX 967
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City | DUNCANSVILLE
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State | PA
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Zip | 16635-8380
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JASON E HENDRICKS
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Credential |
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Telephone | 814-940-0407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 457040
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 457040
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License Number State | PA
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