NPIMap

Organization Active NPI

Tabitha Grand Island, Inc

  • Assisted Living Facility
  • Grand Island, NE
National Provider Identifier
1760125199
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
TABITHA GRAND ISLAND, INC
Practice address
3490 Ewoldt St
Grand Island, NE 68803-3134
Phone
(308) 833-6112
NPI assigned
Apr 14, 2022
Organization subpart
Yes
Parent organization
TABITHA GRAND ISLAND, INCAs reported in NPPES

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

3490 Ewoldt St
Grand Island, NE 68803-3134

Mailing address

4720 Randolph St
Lincoln, NE 68510-3741
Phone (402) 484-9711

Other names 1

  • Tabitha at Prairie Commons Assisted Living and Memory Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tabitha Grand Island Inc2 organizations share this tax ID, including this one
Part of
Tabitha Grand Island Inc

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1760125199",
    "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": "402-484-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3490 EWOLDT ST",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688033134",
            "telephone_number": "308-833-6112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABITHA GRAND ISLAND, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TABITHA GRAND ISLAND, INC",
        "enumeration_date": "2022-04-14",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tabitha at Prairie Commons Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tabitha at Prairie Commons Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Island, NE

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.