Provider Demographics
NPI:1679630792
Name:TABITHA, INC.
Entity Type:Organization
Organization Name:TABITHA, INC.
Other - Org Name:TABITHA OF CRETE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT / CFO
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:402-483-7671
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 1:1540 GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-1749
Practice Address - Country:US
Practice Address - Phone:402-483-7671
Practice Address - Fax:402-486-8539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABITHA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENH0003313M00000X
313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025440100Medicaid
NE285283Medicare Oscar/Certification