Provider Demographics
NPI:1326295346
Name:PCDI HEALTHCARE AND CONSULTANTS/ THE WALLACE GROUP
Entity Type:Organization
Organization Name:PCDI HEALTHCARE AND CONSULTANTS/ THE WALLACE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DE'WAYN'E
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:972-955-1911
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 1:638 CEDARCLIFF DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4208
Practice Address - Country:US
Practice Address - Phone:972-955-1911
Practice Address - Fax:214-467-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32016909494OtherHOME HEALTH