# HERITAGE REHAB, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679551808
- **Authorized official:** KARL MILLER JR. (CEO)
- **Authorized official phone:** (503) 570-3405

## Contact information

- **Practice address:** 7411 PACIFIC AVE, TACOMA, WA 98408-7118
- **Practice address phone:** (253) 474-8456
- **Practice address fax:** (253) 471-2076
- **Mailing address:** 25117 SW PARKWAY AVE, SUITE F, WILSONVILLE, OR 97070-9697

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH1252 | WA | Yes |

## Other

- **Enumeration date:** 01/06/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4112520 | — | WA |