Healthcare Provider Details

I. General information

NPI: 1043454614
Provider Name (Legal Business Name): PCDI HEALTHCARE AND CONSULTANTS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 UPTOWN BLVD STE 2000
CEDAR HILL TX
75104-3528
US

IV. Provider business mailing address

638 CEDARCLIFF DR
DALLAS TX
75217-4208
US

V. Phone/Fax

Practice location:
  • Phone: 469-445-9866
  • Fax: 972-863-3091
Mailing address:
  • Phone: 972-955-1911
  • Fax: 214-467-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number32016909494
License Number StateTX

VIII. Authorized Official

Name: DR. ANTHONY D WALLACE
Title or Position: EXECUTIVE ADMINISTRATOR
Credential: DRPH
Phone: 469-445-9866