Healthcare Provider Details

I. General information

NPI: 1679895163
Provider Name (Legal Business Name): DECATUR HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 12TH AVE.
FORT WORTH TX
76104-2516
US

IV. Provider business mailing address

850 12TH AVE
FORT WORTH TX
76104-2516
US

V. Phone/Fax

Practice location:
  • Phone: 817-882-8289
  • Fax: 817-882-8290
Mailing address:
  • Phone: 817-882-8289
  • Fax: 817-882-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number140335
License Number StateTX

VIII. Authorized Official

Name: BRIAN TODD SCROGGINS
Title or Position: CEO
Credential:
Phone: 940-900-4348