- Enrollment id
- O20150119000535
- Enrollment state
- TX
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1407253511
- Multiple npi flag
- N
- Ccn
- 455881
- Associate id
- 8325951346
- Organization name
- DECATUR HOSPITAL AUTHORITY
- Doing business as name
- DFW NURSING & REHAB
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Nursing home provider name
- DFW NURSING & REHAB
- Address line 1
- 900 W LEUDA ST
- City
- FORT WORTH
- State
- TX
- Zip code
- 761043002