Healthcare Provider Details

I. General information

NPI: 1740340934
Provider Name (Legal Business Name): PYRAMID HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 FRONT ST
CISCO TX
76437-3636
US

IV. Provider business mailing address

PO BOX 2105
WHITNEY TX
76692-5105
US

V. Phone/Fax

Practice location:
  • Phone: 254-442-4202
  • Fax: 254-442-1174
Mailing address:
  • Phone: 254-580-9424
  • Fax: 254-580-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number112580
License Number StateTX

VIII. Authorized Official

Name: MRS. PATRICIA DIANE WARD
Title or Position: CEO PRESIDENT
Credential: RN
Phone: 254-580-9424