NPIMap

Organization Active NPI

Tabitha, Inc.

Doing business as Tabitha Nursing and Rehab Center

  • Skilled Nursing Facility
  • Lincoln, NE
National Provider Identifier
1225117385
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
504009 Issued in NE
Legal business name
TABITHA, INC.
Doing business as
Tabitha Nursing and Rehab Center
Practice address
4720 Randolph Street
Lincoln, NE 68510-3741
Phone
(402) 483-7671
Fax
(402) 486-8539
NPI assigned
Nov 2, 2006
Last updated
Dec 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Renae Endicott
Title
Assistant Director of Finance
Phone
(402) 484-9711

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 504009 NE
Skilled Nursing Facility 314000000X 504009 NE Primary

Addresses

Primary practice location

4720 Randolph Street
Lincoln, NE 68510-3741

Mailing address

4720 Randolph St
Lincoln, NE 68510-3741

Other identifiers 2

IdentifierTypeStateIssuer
00525OtherNESNF (BCBS OF NE)
08982OtherNEDME/SUPPLIES (BCBS OF NE)

Other names 1

  • Tabitha Nursing and Rehab Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722001028 NE Part A Provider - Skilled Nursing Facility 3274421284 Practice locations: Lincoln, NE
O20050201000661 NE Part B Supplier - Clinic/Group Practice 3274421284 Receives reassigned benefits from 1 practitioner
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Franklin, NE; Holdrege, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225117385. Details of each certification follow.

Skilled nursing facility certification: CCN 285057

Legal name
TABITHA, INC.
Doing business as
EVENTIDE LINCOLN CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1981
Last certification
Dec 17, 2024
Beds
197
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
4720 Randolph St
Lincoln, NE 68510-3741
Nursing home name
EVENTIDE LINCOLN CARE CENTER

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Eventide Lincoln Care CenterCCN 285057 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1981
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
197135.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Eventide4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jon M Riewer Individual Corporate Officer Oct 10, 2024
Karla Swenson Individual Corporate Director Oct 10, 2024
Eric Schafer Individual Corporate Director Jan 1, 2013
Eventide Nebraska Senior Living LLC Organization, Moorhead, MN LLC, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 10, 2024 100%
Darin G Ohe Individual Operational/Managerial Control Nov 20, 2024
Robert J Bye Individual Corporate Officer Oct 10, 2024
Corporate Director Oct 10, 2024
Peter J Seljevold Individual Corporate Director Oct 10, 2024
Brandon Lunak Individual Corporate Director Oct 10, 2024
Tyler Fischbach Individual Corporate Director Oct 10, 2024
Bethany Elizabeth Feis Individual Adp of the SNF Apr 10, 2026
Jodee Bock Individual Corporate Director Oct 10, 2024
Patrick Gulbranson Individual Corporate Director Oct 10, 2024
Jessica Guerrero Individual Operational/Managerial Control Apr 1, 2026
Adp of the SNF Apr 10, 2026
Terry Brandt Individual Corporate Director Oct 10, 2024
Eventide Organization, Moorhead, MN Corporation, Non-profit, Chain home office Operational/Managerial Control Nov 20, 2024
Judith Lee Individual Corporate Director Oct 10, 2024
Cindy Larson-Casselton Individual Corporate Director Oct 10, 2024
Cory E Shield Individual Adp of the SNF Apr 10, 2026
Vikki Johnson Individual Corporate Officer Oct 10, 2024
Corporate Director Oct 10, 2024

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eventide Prairie Commons Care CenterGrand Island, NE, CCN 285307 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 22, 2022
Tabitha Hospice-a Collaboration With ImmanuelOmaha, NE, CCN 281556 Hospice 5% Or Greater Direct Ownership Interest (75%) Dec 13, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1225117385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 RANDOLPH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685103741",
            "fax_number": "402-486-8539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 RANDOLPH STREET",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685103741",
            "telephone_number": "402-483-7671",
            "fax_number": "402-486-8539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABITHA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "ENDICOTT",
        "authorized_official_first_name": "RENAE",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "402-484-9711"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NE",
            "license": "504009",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "504009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SNF (BCBS OF NE)",
            "identifier": "00525",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME/SUPPLIES (BCBS OF NE)",
            "identifier": "08982",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tabitha Nursing and Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.