# JOHNSON MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Waters of Wakarusa Skilled Nursing Facility
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962425306
- **Authorized official:** DAVID DUNKLE MD (PRESIDENT/CEO)
- **Authorized official phone:** (317) 736-3396

## Contact information

- **Practice address:** 300 N WASHINGTON ST, WAKARUSA, IN 46573-9590
- **Practice address phone:** (574) 862-4511
- **Practice address fax:** (574) 862-4005
- **Mailing address:** 1125 W JEFFERSON ST, FRANKLIN, IN 46131-2140
- **Mailing address phone:** (317) 736-7549
- **Mailing address fax:** (317) 736-2692

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 06-000521-1 | IN | Yes |
| 332BN1400X | Nursing Facility Supplies (DME) | — | — | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | IN | — |

## Other

- **Enumeration date:** 07/26/2006
- **Last updated:** 01/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100266980A | — | IN |