Healthcare Provider Details

I. General information

NPI: 1477674968
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 W RANDOL MILL RD
ARLINGTON TX
76012-4228
US

IV. Provider business mailing address

4150 INTERNATIONAL PLZ STE 600
FORT WORTH TX
76109-4831
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-6789
  • Fax:
Mailing address:
  • Phone: 817-348-8959
  • Fax: 817-348-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114501
License Number StateTX

VIII. Authorized Official

Name: CLARK SANDERSON
Title or Position: BOARD PRESIDENT
Credential:
Phone: 903-583-1854