Healthcare Provider Details

I. General information

NPI: 1679551808
Provider Name (Legal Business Name): HERITAGE REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 PACIFIC AVE
TACOMA WA
98408-7118
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 253-474-8456
  • Fax: 253-471-2076
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1252
License Number StateWA

VIII. Authorized Official

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