Healthcare Provider Details

I. General information

NPI: 1194747287
Provider Name (Legal Business Name): JOHNSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 N COUNTY ROAD 825 E
HOPE IN
47246-9702
US

IV. Provider business mailing address

1125 W JEFFERSON ST
FRANKLIN IN
46131-2140
US

V. Phone/Fax

Practice location:
  • Phone: 812-546-4416
  • Fax: 812-546-0664
Mailing address:
  • Phone: 317-736-3396
  • Fax: 317-736-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05-000286-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. STEVEN J BERKHOUSE
Title or Position: CFO
Credential:
Phone: 317-346-7939