Provider Demographics
NPI:1043454614
Name:PCDI HEALTHCARE AND CONSULTANTS OF TEXAS
Entity Type:Organization
Organization Name:PCDI HEALTHCARE AND CONSULTANTS OF TEXAS
Other - Org Name:P.C.D.I. HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:469-445-9866
Mailing Address - Street 1:638 CEDARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4208
Mailing Address - Country:US
Mailing Address - Phone:972-955-1911
Mailing Address - Fax:214-467-4315
Practice Address - Street 1:610 UPTOWN BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3528
Practice Address - Country:US
Practice Address - Phone:469-445-9866
Practice Address - Fax:972-863-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
TX32016909494251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management