| Pyramid Walden, Llc | |
|
21770 Fdr Blvd Lexington Park MD 20653-1558 | |
| (301) 863-6661 | |
| Not Available |
| Full Name | Pyramid Walden, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 21770 Fdr Blvd, Lexington Park, Maryland |
| Authorized Official Name and Position | Jason Hendricks (CEO) |
| Authorized Official Contact | 1489400407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pyramid Walden, Llc 30007 Business Center Dr Charlotte Hall MD 20622-3101 Ph: (301) 997-1300 | Pyramid Walden, Llc 21770 Fdr Blvd Lexington Park MD 20653-1558 Ph: (301) 863-6661 |
| NPI Number | 1134563992 |
|---|---|
| Provider Enumeration Date | 04/24/2013 |
| Last Update Date | 04/10/2024 |
| Certification Date | 04/10/2024 |
| Medicare PECOS PAC ID | 1052654035 |
|---|---|
| Medicare Enrollment ID | O20190514002090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134563992 | NPI | - | NPPES |
| 613202202 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 5863 (Maryland) | Primary |
| Provider Name | Mary Beth Voorhees |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497733695 PECOS PAC ID: 5597081869 Enrollment ID: I20150303002525 |
| Provider Name | Bolanle Saba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063079879 PECOS PAC ID: 3577996719 Enrollment ID: I20201014003264 |
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