# TABITHA GRAND ISLAND, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tabitha at Prairie Commons
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568105989
- **Authorized official:** RENAE ENDICOTT (ASSISTANT DIRECTOR OF FINANCE)
- **Authorized official phone:** (402) 484-9711

## Contact information

- **Practice address:** 3490 EWOLDT ST, GRAND ISLAND, NE 68803-3134
- **Practice address phone:** (308) 833-6112
- **Mailing address:** 4720 RANDOLPH ST, LINCOLN, NE 68510-3741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/14/2022
- **Last updated:** 12/12/2024