Organization
WITHAM MEMORIAL HOSPITAL
Active
Other names
Brooke Knoll Village
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BRAVERMAN (CEO, PRESIDENT)
(765) 485-8100
Entity
Organization
Contact information
Practice address
1108 KINGWOOD DRIVE, AVON, IN 46123-5500
(317) 204-1100
(317) 271-7054
Mailing address
8455 KEYSTONE CROSSING, INDIANAPOLIS, IN 46240-4353
(317) 818-1240
(317) 552-2086
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
13-012901-1
IN
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300023505
—
IN
Enumeration date
10/01/2013
Last updated
07/02/2024
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