Organization
JOHNSON MEMORIAL HOSPITAL
Active
Other names
The Waters of Sullivan Skilled Nursing Facility
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID DUNKLE MD (PRESIDENT/CEO)
(317) 736-3396
Entity
Organization
Contact information
Practice address
505 WEST WOLFE STREET, SULLIVAN, IN 47882
(812) 268-6361
(812) 268-4454
Mailing address
1125 W JEFFERSON ST, FRANKLIN, IN 46131-2140
(317) 736-7549
(317) 736-2692
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
06-000163-1
IN
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100291380A
—
IN
Enumeration date
07/24/2006
Last updated
01/30/2023
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