Provider Demographics
NPI:1568105989
Name:TABITHA GRAND ISLAND, INC
Entity Type:Organization
Organization Name:TABITHA GRAND ISLAND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-486-8545
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:402-484-9711
Mailing Address - Fax:
Practice Address - Street 1:3940 EWOLDT STREET
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:402-484-9416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABITHA GRAND ISLAND, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility