NPIMap

Organization Active NPI

Witham Memorial Hospital

Doing business as Persimmon Ridge Rehabilitation Centre

  • Skilled Nursing Facility
  • Portland, IN
National Provider Identifier
1811196843
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
11-000148-1 Issued in IN
Legal business name
WITHAM MEMORIAL HOSPITAL
Doing business as
Persimmon Ridge Rehabilitation Centre
Practice address
200 N Park St
Portland, IN 47371-1249
Phone
(260) 726-9355
NPI assigned
Jul 11, 2007
Last updated
Jun 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 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 11-000148-1 IN Primary

Addresses

Primary practice location

200 N Park St
Portland, IN 47371-1249

Mailing address

9480 Priority Way West Dr
Indianapolis, IN 46240-1470
Phone (317) 818-1240

Other identifiers 1

IdentifierTypeStateIssuer
100275500MedicaidIN

Other names 1

  • PERSIMMON RIDGE REHABILITATION CENTRE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120215000654 IN Part A Provider - Skilled Nursing Facility 4082523170 Practice locations: Portland, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811196843. Details of each certification follow.

Skilled nursing facility certification: CCN 155526

Legal name
WITHAM MEMORIAL HOSPITAL
Doing business as
PERSIMMON RIDGE REHABILITATION CENTRE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 30, 1994
Last certification
Aug 16, 2024
Beds
100
Ownership / control type
Nonprofit Corporation
Multi-facility organization
BOT Flavis Witham Mem. Hospital dba Persimmon Ridge Rehab. Center
Organization structure
GovernmentNon-profit
Enrollment address
200 N Park St
Portland, IN 47371-1249
Nursing home name
PERSIMMON RIDGE REHABILITATION CENTRE
Affiliated entity
HCF MANAGEMENT INDIANA

Care Compare: Nursing home

Medicare Care Compare
Listed as
Persimmon Ridge Rehabilitation CentreCCN 155526 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 30, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10083.2 residents per day on average
Chain
HCF Management Indiana6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Witham Health Services37 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 17

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

NameRoleSinceShare
Stuart B Reed Individual Operational/Managerial Control Nov 1, 2011
Magnolia Health Systems Inc Organization, Indianapolis, IN Corporation Adp of the SNF Nov 1, 2011
Jonathan Ward Individual Adp of the SNF Nov 1, 2011
Julie Reagan Individual Corporate DirectorBoard Trustee Sep 25, 2024
Kelly Braverman Individual Corporate OfficerCeo, President Dec 1, 2021 100%
Melinda Hodgson Individual Operational/Managerial Control Oct 28, 2025
Adp of the SNF Oct 28, 2025
Magnolia Health Management Xxiv LLC Organization, Indianapolis, IN LLC, For-profit Operational/Managerial Control Nov 1, 2011 100%
Witham Memorial Hospital Organization, Lebanon, IN 5% Or Greater Direct Ownership Interest Nov 1, 2011 100%
Daniel E Sellers Individual Corporate OfficerSVP-Cfo Jun 20, 2024
Magnolia Health Systems 55, LLC Organization, Indianapolis, IN LLC Adp of the SNF Dec 9, 2025
Michael Jason Hornbecker Individual Corporate DirectorBoard Trustee Jan 1, 2024
Andrea Castetter Individual Corporate DirectorBoard Trustee Jan 1, 2023
J. Frank Vormohr Individual Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 19, 2025
Sabra Health Care Limited Partnership Organization, Tustin, CA Adp of the SNF Nov 1, 2011
Claude a Hawkins Individual Corporate DirectorBoard Trustee Sep 1, 2013
John W Brand Individual Corporate DirectorBoard Trustee Jan 1, 2015
Brett Bayston Individual Corporate DirectorBoard Trustee Jan 1, 2023

Owners & managing parties with NPI records 1

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
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
Greenleaf Health CampusElkhart, IN, CCN 155783 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 2

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": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1811196843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9480 PRIORITY WAY WEST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401470",
            "telephone_number": "317-818-1240",
            "fax_number": "317-818-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N PARK ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473711249",
            "telephone_number": "260-726-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITHAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "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": "11-000148-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100275500",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PERSIMMON RIDGE REHABILITATION CENTRE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PERSIMMON RIDGE REHABILITATION CENTRE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, IN

Sources for this page

Verify at the official NPI Registry.