WITHAM MEMORIAL HOSPITAL NPI 1578630810

NPI Information

  • NPI: 1578630810
  • Provider Name: WITHAM MEMORIAL HOSPITAL
  • Classification: Skilled Nursing Facility - 3140N1450X
  • Specialization: Nursing Care, Pediatric
  • Entity Type: Organization
  • Doing Business As: CAMELOT CARE CENTER
  • CLIA Number: 15D0358759
  • Address: 1555 COMMERCE DR
    LOGANSPORT, IN
    ZIP 46947
  • Phone: (574) 753-0404

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NPI Details

WITHAM MEMORIAL HOSPITAL is a nursing care and pediatric skilled nursing facility in Logansport, IN. The provider is a nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. WITHAM MEMORIAL HOSPITAL NPI is 1578630810. The provider is registered as an organization entity type.
The provider Is Doing Business As Camelot Care Center.

The provider's business location address is:

1555 COMMERCE DR
LOGANSPORT, IN
ZIP 46947-555
Phone: (574) 753-0404
Fax: (574) 722-4638

The provider's authorized official is Kelly Braverman .
The authorized official title is Ceo, President and has the following contact phone number (765) 485-8100.

The CLIA number assigned to this NPI record is 15D0358759 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/30/2006 and was last updated on 6/24/2022.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1314000000XSkilled Nursing FacilityNo
23140N1450XSkilled Nursing FacilityNursing Care, Pediatric06 000466 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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100289810MEDICAIDINDIANA

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: 11/21/2025

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