NPIMap

Organization Active NPI

Witham Memorial Hospital

Doing business as Greenleaf Health Campus

  • Skilled Nursing Facility
  • Elkhart, IN
National Provider Identifier
1205153269
Registry record updated Mar 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WITHAM MEMORIAL HOSPITAL
Doing business as
Greenleaf Health Campus
Practice address
1201 E Beardsley Ave
Elkhart, IN 46514-3574
Phone
(574) 206-0086
Fax
(574) 266-3673
NPI assigned
Apr 29, 2010
Last updated
Mar 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly Braverman
Title
Ceo, President
Phone
(765) 485-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1201 E Beardsley Ave
Elkhart, IN 46514-3574

Mailing address

PO Box 221648
Louisville, KY 40252-1648
Phone (502) 412-5847

Other identifiers 1

IdentifierTypeStateIssuer
201056540MedicaidIN

Other names 1

  • Greenleaf Health Campus Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150706001900 IN Part A Provider - Skilled Nursing Facility 4082523170 Practice locations: Elkhart, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205153269. Details of each certification follow.

Skilled nursing facility certification: CCN 155783

Legal name
WITHAM MEMORIAL HOSPITAL
Doing business as
GREENLEAF HEALTH CAMPUS
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jul 20, 2010
Last certification
Sep 17, 2024
Beds
124 (60 certified)
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Trilogy Health Services Llc
Organization structure
OtherNon-profit
Enrollment address
1201 E Beardsley Ave
Elkhart, IN 46514-3574
Nursing home name
GREENLEAF HEALTH CAMPUS
Affiliated entity
TRILOGY HEALTH SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Greenleaf Health CampusCCN 155783 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 20, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6057.1 residents per day on average
Chain
Trilogy Health Services123 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
James Anthony Boudreau37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Julie Reagan Individual Managing Control - Governing BodyBoard Trustee Sep 25, 2024
American Healthcare Reit Inc Organization, Irvine, CA Real estate investment trust (REIT) Adp of the SNF Oct 1, 2018
Kelly Braverman Individual Operational/Managerial Control Dec 1, 2021
Trilogy Real Estate Investment Trust Organization, Irvine, CA Real estate investment trust (REIT) Adp of the SNF Dec 1, 2015
Trilogy Reit Holdings LLC Organization, Irvine, CA LLC Adp of the SNF Dec 1, 2015
Brittney Plantinga Individual Operational/Managerial Control Oct 23, 2022
Adp of the SNF Jul 11, 2025
Trilogy Management Services LLC Organization, Louisville, KY Management services company Adp of the SNF Dec 1, 2015
Gahc3 Trilogy JV LLC Organization, Irvine, CA LLC Adp of the SNF Dec 1, 2015
Witham Memorial Hospital Organization, Lebanon, IN 5% Or Greater Direct Ownership Interest May 1, 2015 100%
Daniel E Sellers Individual Operational/Managerial Control Jun 20, 2024
American Healthcare Reit Holdings LP Organization, Irvine, CA Holding company Adp of the SNF Dec 1, 2015
Trilogy Healthcare Master Tenant II, LLC Organization, Louisville, KY LLC Adp of the SNF Jul 10, 2025
Michael Jason Hornbecker Individual Managing Control - Governing BodyBoard Trustee Jan 1, 2024
Israr a Siddiqi Individual Operational/Managerial Control Jul 1, 2015
Adp of the SNF Apr 16, 2026
Andrea Castetter Individual Managing Control - Governing BodyBoard Trustee Jan 1, 2023
Claude a Hawkins Individual Managing Control - Governing BodyBoard Trustee Sep 1, 2013
John W Brand Individual Managing Control - Governing BodyBoard Trustee Jan 1, 2015
Trilogy Healthcare of Elkhart, LLC Organization, Elkhart, IN LLC Operational/Managerial Control May 1, 2015
Paragon Outpatient Rehabilitation Services LLC Organization, Louisville, KY Medical provider/supplier Adp of the SNF Dec 1, 2015
Trilogy Investors LLC Organization, Louisville, KY LLC Adp of the SNF Dec 1, 2015
Brett Bayston Individual Managing Control - Governing BodyBoard Trustee Jan 1, 2023
Continental Merger Sub LLC Organization, Irvine, CA LLC Adp of the SNF Oct 1, 2021
Gahc4 Trilogy JV LLC Organization, Irvine, CA LLC Adp of the SNF Oct 1, 2018

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 31

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Witham Health ServicesLebanon, IN, CCN 150104 Hospital Operational/Managerial Control (100%) Nov 24, 2011
Ambassador HealthcareCenterville, IN, CCN 155490 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2011
Vermillion Convalescent CenterClinton, IN, CCN 155124 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Twin City HealthcareGas City, IN, CCN 155232 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Westridge Health Care CenterTerre Haute, IN, CCN 155234 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Persimmon Ridge Rehabilitation CentrePortland, IN, CCN 155526 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Grand Valley Health & RehabMartinsville, IN, CCN 155605 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Willow Crossing Health & Rehabilitation CenterColumbus, IN, CCN 155535 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Pineknoll Rehabilitation CentreWinchester, IN, CCN 155527 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Camelot Care CenterLogansport, IN, CCN 155385 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2012
Alexandria Care CenterAlexandria, IN, CCN 155521 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2012
White Oak Health CampusMonticello, IN, CCN 155782 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
St Mary Healthcare CenterLafayette, IN, CCN 155094 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
Waterford Place Health CampusKokomo, IN, CCN 155678 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
Cumberland Pointe Health CampusWest Lafayette, IN, CCN 155775 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Blair Ridge Health CampusPeru, IN, CCN 155791 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Woodbridge Health CampusLogansport, IN, CCN 155724 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
St Elizabeth Healthcare CenterDelphi, IN, CCN 155290 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Homewood Health CampusLebanon, IN, CCN 155680 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Arlington Place Health CampusIndianapolis, IN, CCN 155816 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Wellbrooke of WabashWabash, IN, CCN 155806 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Wellbrooke of KokomoKokomo, IN, CCN 155819 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
The Villages at Historic SilvercrestNew Albany, IN, CCN 155813 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
The Springs at LafayetteLafayette, IN, CCN 155829 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Wellbrooke of CarmelCarmel, IN, CCN 155833 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Clearvista Lake Health CampusIndianapolis, IN, CCN 155815 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
McGivney Health Care CenterCarmel, IN, CCN 155855 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2015
Brooke Knoll VillageAvon, IN, CCN 155814 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2021
Westminster Village KentuckianaClarksville, IN, CCN 155191 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2023
Suburban Home Health, LLCNoblesville, IN, CCN 157092 Home health agency 5% Or Greater Indirect Ownership Interest (10.27%) Sep 3, 2024
Suburban HospiceNoblesville, IN, CCN 151547 Hospice 5% Or Greater Indirect Ownership Interest (10.27%) Nov 1, 2024

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648252800000",
    "number": "1205153269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221648",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402521648",
            "telephone_number": "502-412-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E BEARDSLEY AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465143574",
            "telephone_number": "574-206-0086",
            "fax_number": "574-266-3673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITHAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-29",
        "last_updated": "2022-03-26",
        "certification_date": "2022-03-26",
        "status": "A",
        "authorized_official_last_name": "BRAVERMAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO, PRESIDENT",
        "authorized_official_telephone_number": "765-485-8100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201056540",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenleaf Health Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greenleaf Health Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.