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General NPI Number Information
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NPI Number | 1679551808
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Entity Type | Organization
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Legal Business Name | HERITAGE REHAB, INC.
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7411 PACIFIC AVE
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City | TACOMA
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State | WA
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Zip | 98408-7118
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Country | US
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Telephone | 253-474-8456
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Fax | 253-471-2076
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Provider Business Mailing Address
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Address Line | 25117 SW PARKWAY AVE SUITE F
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City | WILSONVILLE
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State | OR
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Zip | 97070-9697
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KARL MILLER JR.
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Credential |
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Telephone | 503-570-3405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH1252
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License Number State | WA
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