Provider Demographics
NPI:1801971387
Name:TABITHA, INC.
Entity type:Organization
Organization Name:TABITHA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:4720 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?:Yes
Parent Organization LBN:TABITHA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========08Medicaid
NE086209Medicare Oscar/Certification
NE110242520Medicare ID - Type UnspecifiedPROFESSIONAL SVCS (RR)