Organization
JAMES W WALLACE DBA SOUTHERN WIND MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA DYER (ADMINISTRATOR)
(903) 855-1555
Entity
Organization
Contact information
Practice address
618 QUITMAN ST, PITTSBURG, TX 75686-1086
(903) 855-1555
(903) 855-1585
Mailing address
618 QUITMAN ST, PITTSBURG, TX 75686-1086
(903) 855-1555
(903) 855-1585
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
118382
TX
Other
Enumeration date
02/12/2007
Last updated
08/22/2020
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