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JOHNSON MEMORIAL HOSPITAL NPI 1255352399


NPI Information

NPI: 1255352399
Provider Name: JOHNSON MEMORIAL HOSPITAL

Doing Business As: THE WATERS OF LAGRANGE SKILLED NURSING FACILITY

Classification: Skilled Nursing Facility - 314000000X
Entity Type: Organization
Address:
787 N DETROIT ST
LAGRANGE, IN
ZIP 46761
Phone: (574) 466-2172
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JOHNSON MEMORIAL HOSPITAL is a skilled nursing facility in Lagrange, IN. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. JOHNSON MEMORIAL HOSPITAL NPI is 1255352399. The provider is registered as an organization entity type.
The provider Is Doing Business As The Waters Of Lagrange Skilled Nursing Facility.

The provider's business location address is:

787 N DETROIT ST
LAGRANGE, IN
ZIP 46761-111
Phone: (574) 466-2172
Fax: (574) 463-2180

The provider's authorized official is David Dunkle .
The authorized official title is President/ceo and has the following contact phone number (317) 736-3396.

The enumeration date for this NPI number is 7/22/2006 and was last updated on 1/30/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332BN1400XDurable Medical Equipment & Medical SuppliesNursing Facility SuppliesNo
2332BP3500XDurable Medical Equipment & Medical SuppliesParenteral & Enteral NutritionINDIANANo
3314000000XSkilled Nursing Facility06-000049-1INDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1100270890AMEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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