Provider Demographics
NPI:1720163298
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:
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:2006-10-25
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE501017251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0221-01OtherHHA (HMO NEBRASKA)
NE08982OtherDME/SUPPLIES (BCBS OF NE)
NE60-00010OtherHHA (UHC/AARP)
NE60-00010OtherHHA (UHC/AARP)
NE=========11Medicaid
NE=========12Medicaid
NE=========16Medicaid
NE=========01Medicaid
NE00365OtherHHA (BCBS OF NE)
NE0221-01OtherHHA (HMO NEBRASKA)
NE08982OtherDME/SUPPLIES (BCBS OF NE)
NE=========13Medicaid
NE=========10Medicaid