Active NPI
Georgian Rehab, LLC
Doing business as Avamere Transitional Care of Puget Sound
- Skilled Nursing Facility
- Tacoma, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- GEORGIAN REHAB, LLC
- Doing business as
- Avamere Transitional Care of Puget Sound
- Practice address
- 630 S Pearl St
Tacoma, WA 98465-2111 - Phone
- (253) 671-7300
- NPI assigned
- Feb 2, 2007
- Last updated
- Jan 21, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karl Miller Jr.
- Title
- Ceo
- Phone
- (503) 570-3405
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
630 S Pearl St
Tacoma, WA 98465-2111
Mailing address
25117 SW Parkway Ave
Suite F
Wilsonville, OR 97070-9697
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50-5529 | Other | WA | MEDICARE OSCAR |
Other names 1
- Avamere Transitional Care of Puget Sound
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161109001074 | WA | Part A Provider - Skilled Nursing Facility | 1951404854 | Practice locations: Tacoma, WA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1508904467. Details of each certification follow.
Skilled nursing facility certification: CCN 505529
- Legal name
- GEORGIAN REHAB LLC
- Doing business as
- AVAMERE TRANSITIONAL CARE OF PUGET SOUND
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 27, 2017
- Last certification
- Jul 31, 2024
- Beds
- 60
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Avamere
- Organization structure
- LLC
- Enrollment address
- 630 S Pearl St
Tacoma, WA 98465-2111 - Nursing home name
- AVAMERE TRANSITIONAL CARE OF PUGET SOUND
- Affiliated entity
- AVAMERE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Avamere Transitional Care of Puget Sound
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Mar 27, 2017
- Medicare certification status
- Active
- Certified beds
- 60
- Chain
- Avamere
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2122298 | Avamere Transitional Care Center of Puget Sound | Certificate of waiver | Apr 4, 2028 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 42
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Avamere Skilled Advisors LLC | Operational/Managerial Control | Jan 1, 2005 | |
| Adp of the SNF | Jul 7, 2025 | ||
| Michelle Funderberg | Managing Control - Governing Body | Jun 1, 2025 | |
| Adp of the SNF | Dec 31, 2024 | ||
| Karl Rickard Miller | 5% Or Greater Indirect Ownership Interest | Jul 1, 1998 | 100% |
| Adp of the SNF | Aug 17, 2017 | ||
| Adp of the SNF | Jul 7, 2025 | ||
| Ari Operations, LLC | 5% Or Greater Indirect Ownership Interest | Jan 6, 2006 | 100% |
| Katherine Fowler | Operational/Managerial Control | Feb 28, 2025 | |
| Adp of the SNF | Feb 28, 2025 | ||
| Bradley J Schmitz | Operational/Managerial Control | Sep 1, 2023 | |
| Adp of the SNF | Sep 1, 2023 | ||
| Adp of the SNF | Jul 7, 2025 | ||
| Andrew Simpson | Operational/Managerial Control | Jun 1, 2024 | |
| Midcap Finco LLC | 5% Or Greater Security Interest | Jan 22, 2010 | 100% |
| Operational/Managerial Control | Jan 22, 2010 | ||
| Glen Robert Cavallo | Managing Control - Governing Body | Jun 1, 2025 | |
| Ariso LLC | 5% Or Greater Direct Ownership Interest | Jan 6, 2006 | 100% |
| Sherrie Wagner | Adp of the SNF | Dec 16, 2025 | |
| Adp of the SNF | Aug 7, 2015 | ||
| Carolyn Staples | Managing Control - Governing Body | Oct 1, 2025 | |
| Adp of the SNF | Oct 5, 2023 | ||
| Karl Rickard Miller Jr Revocable Trust | 5% Or Greater Indirect Ownership Interest | Jul 11, 2011 | 100% |
| Avamere Health Services LLC | Operational/Managerial Control | Jan 1, 2005 | 100% |
| Adp of the SNF | Mar 17, 2026 | ||
| Snapmedtech,Inc. | Adp of the SNF | Sep 8, 2025 | |
| Cindy Throne | Adp of the SNF | Nov 10, 2025 | |
| Adp of the SNF | Jul 7, 2025 | ||
| Adp of the SNF | Jul 7, 2025 | ||
| Tonya Fisher | Operational/Managerial Control | Jan 19, 2026 | |
| Ike Okoli | Operational/Managerial Control | Mar 6, 2023 | |
| Adp of the SNF | Mar 19, 2026 | ||
| Catherine Johnson | Operational/Managerial Control | Oct 9, 2023 | |
| Adp of the SNF | Oct 9, 2023 | ||
| Todd Inskeep | Managing Control - Governing Body | Jun 1, 2025 | |
| Adp of the SNF | Jan 21, 2022 | ||
| Roberto Garcia | Operational/Managerial Control | Feb 1, 2026 | |
| Managing Control - Governing Body | Feb 1, 2026 | ||
| Adp of the SNF | Feb 1, 2026 | ||
| Adp of the SNF | Jul 7, 2025 | ||
| Colby Strunk | Managing Control - Governing Body | Jun 1, 2025 | |
| Adp of the SNF | Sep 6, 2022 | ||
| Glen Roderick | Operational/Managerial Control | Feb 1, 2024 | |
| Adp of the SNF | Feb 1, 2024 | ||
| Loriel Fanunal | Operational/Managerial Control | Jan 2, 2023 | |
| Adp of the SNF | Jan 2, 2023 | ||
| Kim Games | Adp of the SNF | Aug 15, 2024 | |
| Avamere Group LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2006 | 100% |
| Julie Davis | Adp of the SNF | Aug 1, 2024 | |
| Mary Kofstad | Operational/Managerial Control | Feb 13, 2024 | |
| Managing Control - Governing Body | Jun 1, 2025 | ||
| Adp of the SNF | Feb 13, 2024 | ||
| Adp of the SNF | Aug 17, 2017 | ||
| Yolanda Presley | Operational/Managerial Control | Jan 6, 2025 | |
| Adp of the SNF | Jan 6, 2025 | ||
| Cody Feakin | Operational/Managerial Control | Jul 15, 2025 | |
| Managing Control - Governing Body | Jun 1, 2025 | ||
| Adp of the SNF | Jan 1, 2025 | ||
| Misty Dawn Reid | Operational/Managerial Control | Jan 2, 2025 | |
| Managing Control - Governing Body | Jun 1, 2025 | ||
| Adp of the SNF | Jan 2, 2025 | ||
| Adp of the SNF | Apr 8, 2026 | ||
| Carrie Vanderzanden | Managing Control - Governing Body | Jun 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| Adp of the SNF | Aug 17, 2017 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Tacoma, WA
- NPI 1447273990
Adp of the SNF, Operational/Managerial Control
-
- Psychiatric/Mental Health Nurse Practitioner
- Windsor, CO
- NPI 1851992176
Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control
Facilities with the same owner 26
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Avamere Rehabilitation of Burien
- Skilled Nursing Facility
- Burien, WA
- NPI 1912619321
Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC
-
dba Avamere Rehabilitation of Issaquah
- Skilled Nursing Facility
- Issaquah, WA
- NPI 1053023499
Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC
-
- Skilled Nursing Facility
- Shoreline, WA
- NPI 1316932114
Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC
-
- Skilled Nursing Facility
- Seattle, WA
- NPI 1982948535
Avamere Health Services LLC, Avamere Skilled Advisors LLC
-
dba Avamere Olympic Rehabilitation of Sequim
- Skilled Nursing Facility
- Sequim, WA
- NPI 1538146378
Ari Operations, LLC, Ariso LLC, Avamere Group LLC, Avamere Health Services LLC
-
dba Avamere Rehabilitation of Shoreline
- Skilled Nursing Facility
- Shoreline, WA
- NPI 1366154791
Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC
-
dba Avamere Rehabilitation of Park West
- Skilled Nursing Facility
- Seattle, WA
- NPI 1336851773
Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC
-
dba Avamere at Pacific Ridge
- Skilled Nursing Facility
- Tacoma, WA
- NPI 1053459925
Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC
-
dba Avamere Rehabilitation of Cascade Park
- Skilled Nursing Facility
- Vancouver, WA
- NPI 1194120816
Ari Operations, LLC, Ariso LLC, Avamere Group LLC
-
- Skilled Nursing Facility
- Lake Oswego, OR
- NPI 1437176344
Ari Operations, LLC, Avamere Group LLC
-
dba Avamere Rehabilitation of Clackamas
- Skilled Nursing Facility
- Gladstone, OR
- NPI 1518001205
Avamere Health Services LLC, Avamere Skilled Advisors LLC, Karl Rickard Miller Jr Revocable Trust, Midcap Finco LLC
-
dba Avamere Rehabilitation of Coos Bay
- Skilled Nursing Facility
- Coos Bay, OR
- NPI 1831233519
Avamere Health Services LLC, Avamere Skilled Advisors LLC
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Seattle, WA
- NPI 1124097811
-
- Internal Medicine Physician
- Tacoma, WA
- NPI 1447273990
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1737417600000",
"number": "1508904467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25117 SW PARKWAY AVE",
"address_2": "SUITE F",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 S PEARL ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984652111",
"telephone_number": "253-671-7300"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEORGIAN REHAB, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-02",
"last_updated": "2025-01-21",
"certification_date": "2025-01-21",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "KARL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "503-570-3405",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE OSCAR",
"identifier": "50-5529",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "64 S Price Rd Ste B",
"city": "Brownsville",
"state": "TX",
"country_code": "US",
"postal_code": "785212459",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Avamere Transitional Care of Puget Sound",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Avamere Transitional Care of Puget Sound",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.