1023778248 NPI number — TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL

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 1023778248 NPI number — TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL
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:
Provider Other Organization Name Type Code:
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:
1023778248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2021
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:
1044 N 115TH ST STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-819-4949
Provider Business Practice Location Address Fax Number:
531-375-5076
Provider Enumeration Date:
12/29/2021

Additional Information

Authorized Official

Authorized Official Last Name:
EDGERTON
Authorized Official First Name:
THADDEUS
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, FINANCE
Authorized Official Telephone Number:
402-846-8538

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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