# WITHAM MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Greenleaf Health Campus
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205153269
- **Authorized official:** KELLY BRAVERMAN (CEO, PRESIDENT)
- **Authorized official phone:** (765) 485-8100

## Contact information

- **Practice address:** 1201 E BEARDSLEY AVE, ELKHART, IN 46514-3574
- **Practice address phone:** (574) 206-0086
- **Practice address fax:** (574) 266-3673
- **Mailing address:** PO BOX 221648, LOUISVILLE, KY 40252-1648
- **Mailing address phone:** (502) 412-5847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 04/29/2010
- **Last updated:** 03/26/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201056540 | — | IN |