1285631820 NPI number — TABITHA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285631820 NPI number — TABITHA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TABITHA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TABITHA ADULT DAY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285631820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4720 RANDOLPH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-3741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-483-7671
Provider Business Mailing Address Fax Number:
402-486-8539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4525 F ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-484-9600
Provider Business Practice Location Address Fax Number:
402-484-9601
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRINK
Authorized Official First Name:
DARCIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SR VICE PRESIDENT / CFO
Authorized Official Telephone Number:
402-486-8538

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  ADS200902 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100250212-00 . This is a "MEDICAID ADULT DAY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18453968 . This is a "MEDICAID WAIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96404686 . This is a "TITLE 20 - CHILDREN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7482581 . This is a "BLOCK GRANTS" identifier . This identifiers is of the category "OTHER".




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