Healthcare Provider Details

I. General information

NPI: 1841338704
Provider Name (Legal Business Name): HERITAGE REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 PACIFIC AVE
TACOMA WA
98408-7118
US

IV. Provider business mailing address

7411 PACIFIC AVE
TACOMA WA
98408-7118
US

V. Phone/Fax

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

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