Provider Demographics
NPI:1548827751
Name:PYRAMID HOUSE LLC
Entity type:Organization
Organization Name:PYRAMID HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICETA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING-RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-584-1625
Mailing Address - Street 1:6041 MCNAUGHTEN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-5106
Mailing Address - Country:US
Mailing Address - Phone:614-584-1625
Mailing Address - Fax:614-367-6430
Practice Address - Street 1:6041 MCNAUGHTEN GROVE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5106
Practice Address - Country:US
Practice Address - Phone:614-584-1625
Practice Address - Fax:614-367-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH320600000XMedicaid