NPIMap

Organization Active NPI

Pyramid Healthcare Inc.

  • Substance Abuse Rehabilitation Facility
  • East Stroudsburg, PA
National Provider Identifier
1124450069
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
457040 Issued in PA
Legal business name
PYRAMID HEALTHCARE INC.
Practice address
420 Supreme CT
East Stroudsburg, PA 18302-6800
Phone
(814) 940-0407
NPI assigned
Aug 2, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jason E Hendricks
Title
Ceo
Phone
(814) 940-0407

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 457040 PA
Substance Abuse Rehabilitation Facility 324500000X 457040 PA Primary

Addresses

Primary practice location

420 Supreme CT
East Stroudsburg, PA 18302-6800

Mailing address

1894 Plank Rd
PO Box 967
Duncansville, PA 16635-8380

Other identifiers 2

IdentifierTypeStateIssuer
1007625050079MedicaidPA
457040OtherPALICENSE NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Pyramid Healthcare40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Locations

420 Supreme Ct
East Stroudsburg, PA 18302
Phone (570) 213-3300

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1124450069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1894 PLANK RD",
            "address_2": "PO BOX 967",
            "city": "DUNCANSVILLE",
            "state": "PA",
            "postal_code": "166358380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 SUPREME CT",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183026800",
            "telephone_number": "814-940-0407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PYRAMID HEALTHCARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-02",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-940-0407",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "457040",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "PA",
            "license": "457040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007625050079",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "457040",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Stroudsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.