Organization
DECATUR HOSPITAL AUTHORITY
Active
Other names
Ridgmar Medical Lodge
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN TODD SCROGGINS (CEO)
(940) 900-4348
Entity
Organization
Contact information
Practice address
6600 LANDS END CT, FORT WORTH, TX 76116-2100
(817) 665-1971
Mailing address
6600 LANDS END CT, FORT WORTH, TX 76116-2100
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
10/08/2014
Last updated
05/21/2025
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