Active NPI
Tabitha Home Health Care & Hospice LLC-a Collaboration With Immanuel
Doing business as Tabitha Hospice - A Collaboration with Immanuel
- Community Based Hospice Care Agency
- Omaha, NE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL
- Doing business as
- Tabitha Hospice - A Collaboration with Immanuel
- Practice address
- 1044 N 115TH St Ste 202
Omaha, NE 68154-4410 - Phone
- (402) 819-4949
- Fax
- (402) 484-8539
- NPI assigned
- Dec 27, 2021
- Last updated
- Dec 12, 2024
- Organization subpart
- Yes
- Parent organization
- TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL
NPPES NPI Registry
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
1044 N 115TH St Ste 202
Omaha, NE 68154-4410
Mailing address
4720 Randolph St
Lincoln, NE 68510-3741
Phone (402) 483-7671
Other names 1
- Tabitha Hospice - A Collaboration with Immanuel
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221122001539 | NE | Part A Provider - Hospice | 8527436567 | Practice locations: Omaha, NE |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1477213809. Details of each certification follow.
Hospice certification: CCN 281556
- Legal name
- TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL
- Doing business as
- TABITHA HOSPICE-A COLLABORATION WITH IMMANUEL
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Mar 29, 2023
- Last certification
- Mar 14, 2023
- Ownership / control type
- Other
- Organization structure
- LLC
- Incorporated
- Dec 13, 2021 in NE
- Enrollment address
- 1044 N 115TH St
Ste 202
Omaha, NE 68154-4410
Care Compare: Hospice
Medicare Care Compare- Listed as
- Tabitha Hospice-a Collaboration With Immanuel
- Certified
- Mar 29, 2023
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Tabitha Home Health Care Hospice LLC-a Collaboration With Immanuel
- Part of
- Tabitha Home Health Care Hospice LLC-a Collaboration With Immanuel
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Tabitha Home Health Care - a collaboration with Immanuel
- Home Health Agency
- Omaha, NE
- NPI 1023778248
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Tabitha Nursing and Rehab Center
- Skilled Nursing Facility
- Lincoln, NE
- NPI 1225117385
Member Of
Locations
1044 N 115th St
Ste 202
Omaha, NE 68154
Phone (402) 819-4949
Ownership & related parties
All disclosed owners & managing parties 11
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Jon M Riewer | Corporate Director | Feb 1, 2025 | |
| Darin G Ohe | Corporate Director | Nov 8, 2024 | |
| Tabitha, Inc. | 5% Or Greater Direct Ownership Interest | Dec 13, 2021 | 75% |
| Erin L Dahlke | Contracted Managing Employee | Jan 1, 2024 | |
| Eric N Gurley | Corporate Director | Sep 9, 2022 | |
| Scott a. Bear | Corporate Director | Sep 9, 2022 | |
| Patricia L Bauer | Corporate Director | Sep 9, 2022 | |
| Joanie Kush | Corporate Director | Sep 9, 2022 | |
| Bridget J Caniglia | W-2 Managing Employee | Sep 9, 2022 | |
| Operational/Managerial Control | Sep 9, 2022 | ||
| Eventide | 5% Or Greater Indirect Ownership Interest | Oct 10, 2024 | |
| Immanuel | 5% Or Greater Direct Ownership Interest | Dec 13, 2021 | 25% |
Owners & managing parties with NPI records 9
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Tabitha Care
- Case Manager/Care Coordinator
- Holdrege, NE
- NPI 1740525450
5% Or Greater Direct Ownership Interest
-
dba Tabitha Nursing and Rehab Center
- Skilled Nursing Facility
- Lincoln, NE
- NPI 1225117385
5% Or Greater Direct Ownership Interest
-
dba Tabitha Hospice
- Community Based Hospice Care Agency
- Lincoln, NE
- NPI 1275618753
5% Or Greater Direct Ownership Interest
-
dba Tabitha In Crete
- Skilled Nursing Facility
- Crete, NE
- NPI 1679630792
5% Or Greater Direct Ownership Interest
-
dba Tabitha at the Landing
- Skilled Nursing Facility
- Lincoln, NE
- NPI 1699100214
5% Or Greater Direct Ownership Interest
-
dba Tabitha Home Health Care
- Home Health Agency
- Lincoln, NE
- NPI 1720163298
5% Or Greater Direct Ownership Interest
-
- Assisted Living Facility
- Moorhead, MN
- NPI 1487705653
5% Or Greater Indirect Ownership Interest
-
- Skilled Nursing Facility
- West Fargo, ND
- NPI 1942538608
5% Or Greater Indirect Ownership Interest
Facilities with the same owner 12
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Tabitha at Prairie Commons
- Skilled Nursing Facility
- Grand Island, NE
- NPI 1568105989
Eventide, Tabitha, Inc.
-
dba Tabitha Nursing and Rehab Center
- Skilled Nursing Facility
- Lincoln, NE
- NPI 1225117385
Eventide
-
dba Tabitha Hospice
- Community Based Hospice Care Agency
- Lincoln, NE
- NPI 1275618753
Eventide
-
dba Tabitha at the Landing
- Skilled Nursing Facility
- Lincoln, NE
- NPI 1699100214
Eventide
-
dba Ethos Hospice
- Community Based Hospice Care Agency
- Fargo, ND
- NPI 1598200529
Eventide
-
dba Heartland Care Center
- Nursing Facility/Intermediate Care Facility
- Devils Lake, ND
- NPI 1689667834
Eventide
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Family Medicine Physician
- Omaha, NE
- NPI 1134488554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640563200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1733961600000",
"number": "1477213809",
"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",
"telephone_number": "402-483-7671",
"fax_number": "402-486-8539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1044 N 115TH ST STE 202",
"city": "OMAHA",
"state": "NE",
"postal_code": "681544410",
"telephone_number": "402-819-4949",
"fax_number": "402-484-8539"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TABITHA HOME HEALTH CARE & HOSPICE LLC-A COLLABORATION WITH IMMANUEL",
"enumeration_date": "2021-12-27",
"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": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Tabitha Hospice - A Collaboration with Immanuel",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Tabitha Hospice - A Collaboration with Immanuel",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Omaha, NE
- Marguerite Lee Tabbert
- Baraah Tabikh
- Hanaa Tabikh
- Kawthar Tabikh
- Tabitha Home Health Care & Hospice LLC-a Collaboration With Immanuel (Tabitha Home Health Care - a collaboration with Immanuel)
- Kalli Tabler
- Ernesto Taboada Llanes
- Alejandro Taboada Velasco
- Valeria Taborda
- Deandre Caprice Lerone Tabron
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.