Healthcare Provider Details

I. General information

NPI: 1407253511
Provider Name (Legal Business Name): DECATUR HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W LEUDA ST
FORT WORTH TX
76104-3002
US

IV. Provider business mailing address

127 W BROAD ST SUITE 800
LAKE CHARLES LA
70601-4393
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-6600
  • Fax: 337-439-6647
Mailing address:
  • Phone: 337-439-6600
  • Fax: 337-439-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number138915
License Number StateTX

VIII. Authorized Official

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