Basic Information
| Provider Information | |||||||||
| NPI: | 1659988525 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PYRAMID HEALTHCARE, INC. | ||||||||
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| OtherOrganizationName: | PYRAMID HEALTHCARE NEWPORT NEWS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 TUNNEL RD STE B | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288051800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283501000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 245 CHESAPEAKE AVE | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236076038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578177570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2020 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | HENDRICKS | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8149400407 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 323P00000X | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.