Healthcare Provider Details

I. General information

NPI: 1811018476
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: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SOUTH ADAMS STREET
FT WORTH TX
76104-1003
US

IV. Provider business mailing address

4150 INTERNATIONAL PLAZA SUITE 600
FORTH WORTH TX
76109-4831
US

V. Phone/Fax

Practice location:
  • Phone: 817-335-5781
  • Fax: 817-338-0502
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 Number117817
License Number StateTX

VIII. Authorized Official

Name: MR. CLARK SANDERSON
Title or Position: BOARD PRESIDENT
Credential:
Phone: 817-372-7224