Healthcare Provider Details

I. General information

NPI: 1326295346
Provider Name (Legal Business Name): PCDI HEALTHCARE AND CONSULTANTS/ THE WALLACE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 CEDARCLIFF DR
DALLAS TX
75217-4208
US

IV. Provider business mailing address

638 CEDARCLIFF DR
DALLAS TX
75217-4208
US

V. Phone/Fax

Practice location:
  • Phone: 972-955-1911
  • Fax: 214-467-4315
Mailing address:
  • Phone: 972-955-1911
  • Fax: 214-467-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY DE'WAYN'E WALLACE
Title or Position: CEO
Credential: CRNA
Phone: 972-955-1911