Organization
WITHAM MEMORIAL HOSPITAL
Active
Other names
St. Mary Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BRAVERMAN (CEO, PRESIDENT)
(765) 485-8100
Entity
Organization
Contact information
Practice address
2201 CASON ST, LAFAYETTE, IN 47904-2613
(765) 447-4102
(765) 447-7386
Mailing address
PO BOX 221648, LOUISVILLE, KY 40252-1648
(502) 412-5847
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
08-000037-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100291350
—
IN
Enumeration date
12/12/2008
Last updated
03/26/2022
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