# WITHAM MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Brooke Knoll Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598192957
- **Authorized official:** KELLY BRAVERMAN (CEO, PRESIDENT)
- **Authorized official phone:** (765) 485-8100

## Contact information

- **Practice address:** 1108 KINGWOOD DRIVE, AVON, IN 46123-5500
- **Practice address phone:** (317) 204-1100
- **Practice address fax:** (317) 271-7054
- **Mailing address:** 8455 KEYSTONE CROSSING, INDIANAPOLIS, IN 46240-4353
- **Mailing address phone:** (317) 818-1240
- **Mailing address fax:** (317) 552-2086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 13-012901-1 | IN | — |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 10/01/2013
- **Last updated:** 07/02/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 300023505 | — | IN |