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General NPI Number Information
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NPI Number | 1295226512
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Entity Type | Organization
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Legal Business Name | PYRAMID PSYCHIATRIC CARE, LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 2475 UNIVERSITY AVE STE A
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City | GREEN BAY
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State | WI
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Zip | 54302-5099
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Country | US
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Telephone | 920-632-2248
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Fax | 920-351-4826
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Provider Business Mailing Address
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Address Line | 2475 UNIVERSITY AVE STE A
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City | GREEN BAY
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State | WI
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Zip | 54302-5099
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Country | US
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Telephone | 920-632-2248
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Fax | 920-351-4826
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | ANDREW TODD BROCKER
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Credential |
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Telephone | 920-632-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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