Provider Demographics
NPI:1902870686
Name:GEORGIAN REHAB, INC.
Entity Type:Organization
Organization Name:GEORGIAN REHAB, INC.
Other - Org Name:GEORGIAN HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:253-588-2146
Mailing Address - Street 1:8407 STEILACOOM BOULEVARD, SOUTHWEST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98498
Mailing Address - Country:US
Mailing Address - Phone:253-588-2146
Mailing Address - Fax:253-582-3607
Practice Address - Street 1:8407 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4706
Practice Address - Country:US
Practice Address - Phone:253-588-2146
Practice Address - Fax:253-582-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4112512Medicaid
WA4112512Medicaid