Witham Memorial Hospital

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060026671 Issued in IN

Legal business name

WITHAM MEMORIAL HOSPITAL

Practice address

800 Saint Joseph Dr
Kokomo, IN 46901-1983

Phone

(765) 236-1239

Fax

(765) 236-1241

NPI assigned

Oct 29, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Waterford Place Health Campus Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Skilled nursing facility certification: CCN 155678

Legal name

WITHAM MEMORIAL HOSPITAL

Doing business as

WATERFORD PLACE HEALTH CAMPUS

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Sep 21, 2000

Last certification

Feb 17, 2025

Beds

151 (103 certified)

Ownership / control type

Other Nonprofit

Organization structure

OtherNon-profit

Enrollment address

800 Saint Joseph Dr
Kokomo, IN 46901-1983

Nursing home name

WATERFORD PLACE HEALTH CAMPUS

Affiliated entity

TRILOGY HEALTH SERVICES

Listed as

Waterford Place Health CampusCCN 155678

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Sep 21, 2000

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

10375.5 residents per day on average

Chain

Trilogy Health Services123 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Hoosier Enterprises II Inc37 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.

• Hoosier Enterprises II, Inc.

  • Pediatric Skilled Nursing Facility
  • Shelbyville, IN
  • NPI 1801963053
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Martinsville, IN
  • NPI 1013926823
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • New Albany, IN
  • NPI 1124360367
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Wabash, IN
  • NPI 1144564626
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Lafayette, IN
  • NPI 1174768618
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Carmel, IN
  • NPI 1194115386
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Elkhart, IN
  • NPI 1205153269
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Gas City, IN
  • NPI 1235316142
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Alexandria, IN
  • NPI 1245399500
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Winchester, IN
  • NPI 1275732950
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Monticello, IN
  • NPI 1306165915
  NPD tax ID
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Terre Haute, IN
  • NPI 1316061575
  NPD tax ID

All disclosed owners & managing parties 32

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

Owners & managing parties with NPI records 2

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

• Baikadi A Ravindra III, MD

  • Internal Medicine Physician
  • Kokomo, IN
  • NPI 1740280015

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Paragon Outpatient Rehabilitation Services, LLC

  • Rehabilitation Clinic/Center
  • Louisville, KY
  • NPI 1871867325

  Adp of the SNF

  CMS ownership

All facility ownership & control disclosures 31

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

Facilities with the same owner 94

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

• Harrison County Hospital

  • Skilled Nursing Facility
  • Batesville, IN
  • NPI 1427133693

  Trilogy Healthcare Holdings Inc

  CMS ownership
• Henry County Memorial Hospital

  • Skilled Nursing Facility
  • Richmond, IN
  • NPI 1881062586

  Trilogy Healthcare Holdings Inc

  CMS ownership
• Suburban Home Health, LLC

  • Home Health Agency
  • Noblesville, IN
  • NPI 1598872939

  Witham Memorial Hospital

  CMS ownership
• Suburban Hospice Inc

  • Community Based Hospice Care Agency
  • Noblesville, IN
  • NPI 1407963846

  Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Martinsville, IN
  • NPI 1013926823

  Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • New Albany, IN
  • NPI 1124360367

  Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Wabash, IN
  • NPI 1144564626

  Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Lafayette, IN
  • NPI 1174768618

  Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Carmel, IN
  • NPI 1194115386

  Trilogy Healthcare Holdings Inc, Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Elkhart, IN
  • NPI 1205153269

  Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Gas City, IN
  • NPI 1235316142

  Witham Memorial Hospital

  CMS ownership
• Witham Memorial Hospital

  • Skilled Nursing Facility
  • Alexandria, IN
  • NPI 1245399500

  Witham Memorial Hospital

  CMS ownership

Affiliated clinicians 2

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

• Jenna Hillen, NP-C

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1275314254

  Nursing home

  Care Compare affiliation
• Baikadi A Ravindra III, MD

  • Internal Medicine Physician
  • Kokomo, IN
  • NPI 1740280015

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1162080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648252800000",
    "number": "1336225622",
    "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": "800 SAINT JOSEPH DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469011983",
            "telephone_number": "765-236-1239",
            "fax_number": "765-236-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITHAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-29",
        "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": "IN",
            "license": "060026671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200300090",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterford Place Health Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Waterford Place Health Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wisconsin Vision, Inc
• Deborah M Wise, COTA
• Wendy S Wise
• Alexis Wisener
• Chifundo Chikondi Nandi Witasoni, RBT
• Witham Memorial Hospital
• Haven Wolfe
• James T Wolfe, DDS
• Olivia Wolverton
• Heavin Leann Wooden

• All providers in Kokomo, IN
• Skilled Nursing Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.