# WITHAM MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VERMILLION CONVALESCENT CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942372511
- **Authorized official:** KELLY BRAVERMAN (CEO, PRESIDENT)
- **Authorized official phone:** (765) 485-8100

## Contact information

- **Practice address:** 1705 S MAIN ST, CLINTON, IN 47842-2524
- **Practice address phone:** (765) 832-3573
- **Practice address fax:** (765) 832-3420
- **Mailing address:** 9480 PRIORITY WAY WEST DR, INDIANAPOLIS, IN 46240-1470
- **Mailing address phone:** (317) 818-1240
- **Mailing address fax:** (317) 818-1022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 11-000052-1 | IN | Yes |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 06/24/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100290340 | — | IN |