Healthcare Provider Details

I. General information

NPI: 1881001527
Provider Name (Legal Business Name): JOHNSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 MONROE STREET
LA PORTE IN
46350
US

IV. Provider business mailing address

1125 W JEFFERSON ST
FRANKLIN IN
46131-2140
US

V. Phone/Fax

Practice location:
  • Phone: 219-841-8020
  • Fax: 219-325-3715
Mailing address:
  • Phone: 317-736-3300
  • Fax: 574-267-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number14-000194-1
License Number StateIN

VIII. Authorized Official

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