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General NPI Number Information
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NPI Number | 1477674968
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Entity Type | Organization
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Legal Business Name | FANNIN COUNTY HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 2645 W RANDOL MILL RD
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City | ARLINGTON
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State | TX
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Zip | 76012-4228
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Country | US
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Telephone | 817-277-6789
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 INTERNATIONAL PLZ STE 600
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City | FORT WORTH
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State | TX
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Zip | 76109-4831
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Country | US
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Telephone | 817-348-8959
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Fax | 817-348-0466
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | CLARK SANDERSON
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Credential |
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Telephone | 903-583-1854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 114501
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License Number State | TX
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