Provider Demographics
NPI:1225117385
Name:TABITHA, INC.
Entity type:Organization
Organization Name:TABITHA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-484-9711
Mailing Address - Street 1:4720 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:402-486-8539
Practice Address - Street 1:4720 RANDOLPH STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3741
Practice Address - Country:US
Practice Address - Phone:402-483-7671
Practice Address - Fax:402-486-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE504009313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08982OtherDME/SUPPLIES (BCBS OF NE)
NE00525OtherSNF (BCBS OF NE)
NE47037799800Medicaid
NE00525OtherSNF (BCBS OF NE)
NE285057Medicare Oscar/Certification
NE08982OtherDME/SUPPLIES (BCBS OF NE)