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General NPI Number Information
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NPI Number | 1033153762
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Entity Type | Organization
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Legal Business Name | DECATUR HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 5801 BRYANT IRVIN RD
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City | FORT WORTH
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State | TX
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Zip | 76132
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Country | US
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Telephone | 817-346-3030
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Fax | 817-346-1201
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Provider Business Mailing Address
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Address Line | 5801 BRYANT IRVIN RD
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City | FORT WORTH
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State | TX
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Zip | 76132
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Country | US
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Telephone | 817-346-3030
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Fax | 817-346-1201
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Authorized Official
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Title or Position | CEO
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Name | BRIAN TODD SCROGGINS
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Credential |
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Telephone | 940-900-4348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 143861
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License Number State | TX
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