Basic Information
| Provider Information | |||||||||
| NPI: | 1285757435 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PYRAMID HEALTHCARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1894 PLANK RD | ||||||||
| Address2: | P.O. BOX 967 | ||||||||
| City: | DUNCANSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166358380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149400407 | ||||||||
| FaxNumber: | 8149410574 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 FORBES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152195125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124811922 | ||||||||
| FaxNumber: | 4122811570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOLF | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8149400407 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 707229 | PA | N | Agencies | Community/Behavioral Health | 261Q00000X | 707229 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM0801X | 707229 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | 707229 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 707229 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 251K00000X | 707229 | PA | Y | Agencies | Public Health or Welfare |
ID Information
| ID | Type | State | Issuer | Description | 1007625050111 | 05 | PA | MEDICAID | 1007625050112 | 05 | PA | MEDICAID | 1007625050113 | 05 | PA | MEDICAID |