Healthcare Provider Details

I. General information

NPI: 1205142320
Provider Name (Legal Business Name): PCDI HEALTHCARE AND CONSULTANTS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 KALAKAUA AVE SUITE C312
HONOLULU HI
96815-1510
US

IV. Provider business mailing address

1888 KALAKAUA AVE SUITE C312
HONOLULU HI
96815-1510
US

V. Phone/Fax

Practice location:
  • Phone: 469-523-1395
  • Fax:
Mailing address:
  • Phone: 469-523-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY D WALLACE
Title or Position: EXECUTIVE ADMINISTRATOR
Credential: ND
Phone: 469-523-1395