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Organization
WITHAM MEMORIAL HOSPITAL
Active
Organization
WITHAM MEMORIAL HOSPITAL
Active
Other names
Grand Valley Health & Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BRAVERMAN (CEO, PRESIDENT)
(765) 485-8100
Entity
Organization
Contact information
Practice address
621 GRAND VALLEY BLVD, MARTINSVILLE, IN 46151-5875
(765) 342-7114
(765) 349-5773
Mailing address
9480 PRIORITY WAY WEST DR, INDIANAPOLIS, IN 46240-1470
(317) 818-1240
(317) 818-1022
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
110004001
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100266880
—
IN
Enumeration date
08/08/2006
Last updated
06/24/2022
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