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Organization
DECATUR HOSPITAL AUTHORITY
Active
Organization
DECATUR HOSPITAL AUTHORITY
Active
Other names
Grapevine Medical Lodge
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN TODD SCROGGINS (CEO)
(940) 900-4348
Entity
Organization
Contact information
Practice address
1005 IRA E. WOODS PARKWAY, GRAPEVINE, TX 76051-4018
(817) 421-1313
Mailing address
1005 IRA E. WOODS PARKWAY, GRAPEVINE, TX 76051-4018
(817) 421-1313
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67-6101
MEDICARE CCN
TX
Enumeration date
10/09/2014
Last updated
05/21/2025
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