Healthcare Provider Details

I. General information

NPI: 1508904467
Provider Name (Legal Business Name): GEORGIAN REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S PEARL ST
TACOMA WA
98465-2111
US

IV. Provider business mailing address

25117 SW PARKWAY AVE SUITE F
WILSONVILLE OR
97070-9697
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KARL MILLER JR.
Title or Position: CEO
Credential:
Phone: 503-570-3405