# WITHAM MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WITHAM MEMORIAL HOSPITAL
- **Other names:** Ambassador Healthcare
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1770871410
- **Legal business name:** WITHAM MEMORIAL HOSPITAL
- **Authorized official:** KELLY BRAVERMAN (CEO, PRESIDENT)
- **Authorized official phone:** (765) 485-8100

## Contact information

- **Practice address:** 705 E MAIN ST, CENTERVILLE, IN 47330-9676
- **Practice address phone:** (765) 855-3424
- **Practice address fax:** (765) 485-1087
- **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 | 11-000456-1 | IN | Yes |

## Other

- **Enumeration date:** 07/15/2011
- **Last updated:** 03/26/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100288750 | — | IN |