Basic Information
| Provider Information | |||||||||
| NPI: | 1477674828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PYRAMID HEALTH CARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1894 PLANK RD | ||||||||
| Address2: | PO BOX 967 | ||||||||
| City: | DUNCANSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166358380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149400407 | ||||||||
| FaxNumber: | 8143812798 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 PENN AVE | ||||||||
| Address2: | |||||||||
| City: | WILKINSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152212134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122415341 | ||||||||
| FaxNumber: | 4122415394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 05/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | WOLF | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8149400404 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 707233 | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 324500000X | 707233 | PA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 1007625050078 | 05 | PA | MEDICAID | 1007625050076 | 05 | PA | MEDICAID | 1007625050077 | 05 | PA | MEDICAID |