Healthcare Provider Details

I. General information

NPI: 1740525450
Provider Name (Legal Business Name): TABITHA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 WEST AVE
HOLDREGE NE
68949-2226
US

IV. Provider business mailing address

4720 RANDOLPH ST
LINCOLN NE
68510-3741
US

V. Phone/Fax

Practice location:
  • Phone: 308-217-4208
  • Fax:
Mailing address:
  • Phone: 402-486-8538
  • Fax: 402-486-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA R HINRICHS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 402-486-8520