Provider Demographics
NPI:1518288414
Name:TABITHA INC
Entity Type:Organization
Organization Name:TABITHA INC
Other - Org Name:TABITHA IN CRETE: THE GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER & SR. VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-486-8538
Mailing Address - Street 1:4720 RANDOLPH STREET
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:402-483-7671
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:2010-06-15
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF063310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252010-00Medicaid
NE10025201000Medicaid