Provider Demographics
NPI:1245396258
Name:PYRAMID HEALTHCARE CORP
Entity Type:Organization
Organization Name:PYRAMID HEALTHCARE CORP
Other - Org Name:HERITAGE MANOR OF GORMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-580-9424
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-5105
Mailing Address - Country:US
Mailing Address - Phone:254-580-9424
Mailing Address - Fax:254-580-9892
Practice Address - Street 1:600 W. ROOSEVELT
Practice Address - Street 2:
Practice Address - City:GORMAN
Practice Address - State:TX
Practice Address - Zip Code:76454
Practice Address - Country:US
Practice Address - Phone:254-734-2202
Practice Address - Fax:254-734-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119012314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1253930002Medicare ID - Type Unspecified
TX67-5590Medicare ID - Type Unspecified