Organization
WITHAM MEMORIAL HOSPITAL
Active
Other names
Homewood Health Campus
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BRAVERMAN (CEO, PRESIDENT)
(765) 485-8100
Entity
Organization
Contact information
Practice address
2494 N LEBANON ST, LEBANON, IN 46052-1111
(765) 482-2076
(765) 482-2082
Mailing address
PO BOX 221648, LOUISVILLE, KY 40252-1648
(502) 412-5847
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05-002703-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200309250
—
IN
Enumeration date
08/31/2006
Last updated
03/26/2022
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