Provider Demographics
NPI:1881001527
Name:JOHNSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HOSPITAL
Other - Org Name:MILLER'S HEALTH & REHAB BY MILLER'S MERRY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-346-7939
Mailing Address - Street 1:1125 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2140
Mailing Address - Country:US
Mailing Address - Phone:317-736-3300
Mailing Address - Fax:574-267-4908
Practice Address - Street 1:3530 MONROE STREET
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-841-8020
Practice Address - Fax:219-325-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14-000194-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100267790Medicaid
IN155297Medicare Oscar/Certification