Provider Demographics
NPI:1679895163
Name:DECATUR HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DECATUR HOSPITAL AUTHORITY
Other - Org Name:FORT WORTH TRANSITIONAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-626-8671
Mailing Address - Street 1:850 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2516
Mailing Address - Country:US
Mailing Address - Phone:817-882-8289
Mailing Address - Fax:817-882-8290
Practice Address - Street 1:850 12TH AVE.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2516
Practice Address - Country:US
Practice Address - Phone:817-882-8289
Practice Address - Fax:817-882-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140335314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026023Medicaid
TX001026023Medicaid