Organization Active NPI

Georgian Rehab, LLC

Doing business as Avamere Transitional Care of Puget Sound

  • Skilled Nursing Facility
  • Tacoma, WA
National Provider Identifier
1508904467
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
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, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
50-5529OtherWAMEDICARE OSCAR

Other names 1

  • Avamere Transitional Care of Puget Sound Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
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 IDStateProvider typePAC IDDetails
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
LLCProprietary
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 SoundCCN 505529 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 27, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6053.9 residents per day on average
Chain
Avamere27 facilities in the chain
Penalties (3 years)
1Fines totaling $23,319

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2122298Avamere Transitional Care Center of Puget Sound630 S Pearl St, Tacoma, WA 98465Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Avamere Skilled Advisors LLC Organization, Wilsonville, OR LLC, For-profit Operational/Managerial Control Jan 1, 2005
Adp of the SNF Jul 7, 2025
Michelle Funderberg Individual Managing Control - Governing BodyVoting Member Jun 1, 2025
Adp of the SNF Dec 31, 2024
Karl Rickard Miller Individual 5% Or Greater Indirect Ownership Interest Jul 1, 1998 100%
Organization, Tustin, CA Holding company, For-profit Adp of the SNF Aug 17, 2017
Organization, Wilsonville, OR LLC, For-profit Adp of the SNF Jul 7, 2025
Ari Operations, LLC Organization, Wilsonville, OR LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 6, 2006 100%
Katherine Fowler Individual Operational/Managerial Control Feb 28, 2025
Adp of the SNF Feb 28, 2025
Bradley J Schmitz Individual Operational/Managerial Control Sep 1, 2023
Adp of the SNF Sep 1, 2023
Organization, Seattle, WA For-profit Adp of the SNF Jul 7, 2025
Andrew Simpson Individual Operational/Managerial Control Jun 1, 2024
Midcap Finco LLC Organization, Bethesda, MD LLC, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Jan 22, 2010 100%
Operational/Managerial Control Jan 22, 2010
Glen Robert Cavallo Individual Managing Control - Governing BodyNon-Voting Member Jun 1, 2025
Ariso LLC Organization, Wilsonville, OR LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 6, 2006 100%
Sherrie Wagner Individual Adp of the SNF Dec 16, 2025
Organization, Tustin, CA LLC, For-profit Adp of the SNF Aug 7, 2015
Carolyn Staples Individual Managing Control - Governing BodyVoting Member Oct 1, 2025
Adp of the SNF Oct 5, 2023
Karl Rickard Miller Jr Revocable Trust Organization, Ketchum, ID 5% Or Greater Indirect Ownership Interest Jul 11, 2011 100%
Avamere Health Services LLC Organization, Wilsonville, OR LLC, For-profit, Chain home office Operational/Managerial Control Jan 1, 2005 100%
Adp of the SNF Mar 17, 2026
Snapmedtech,Inc. Organization, Atlanta, GA Corporation, Medical staffing company, For-profit Adp of the SNF Sep 8, 2025
Cindy Throne Individual Adp of the SNF Nov 10, 2025
Organization, Omaha, NE LLC, Medical staffing company, For-profit Adp of the SNF Jul 7, 2025
Organization, Spokane Valley, WA Corporation, For-profit Adp of the SNF Jul 7, 2025
Tonya Fisher Individual Operational/Managerial Control Jan 19, 2026
Ike Okoli Individual Operational/Managerial Control Mar 6, 2023
Adp of the SNF Mar 19, 2026
Catherine Johnson Individual Operational/Managerial Control Oct 9, 2023
Adp of the SNF Oct 9, 2023
Todd Inskeep Individual Managing Control - Governing BodyNon-Voting Member Jun 1, 2025
Adp of the SNF Jan 21, 2022
Roberto Garcia Individual Operational/Managerial Control Feb 1, 2026
Managing Control - Governing BodyVoting Member Feb 1, 2026
Adp of the SNF Feb 1, 2026
Organization, Charlotte, NC LLC, For-profit Adp of the SNF Jul 7, 2025
Colby Strunk Individual Managing Control - Governing BodyNon-Voting Member Jun 1, 2025
Adp of the SNF Sep 6, 2022
Glen Roderick Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Loriel Fanunal Individual Operational/Managerial Control Jan 2, 2023
Adp of the SNF Jan 2, 2023
Kim Games Individual Adp of the SNF Aug 15, 2024
Avamere Group LLC Organization, Wilsonville, OR LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2006 100%
Julie Davis Individual Adp of the SNF Aug 1, 2024
Mary Kofstad Individual Operational/Managerial Control Feb 13, 2024
Managing Control - Governing BodyVoting Member Jun 1, 2025
Adp of the SNF Feb 13, 2024
Organization, Tustin, CA Corporation, Holding company, For-profit, Real estate investment trust (REIT) Adp of the SNF Aug 17, 2017
Yolanda Presley Individual Operational/Managerial Control Jan 6, 2025
Adp of the SNF Jan 6, 2025
Cody Feakin Individual Operational/Managerial Control Jul 15, 2025
Managing Control - Governing BodyVoting Member Jun 1, 2025
Adp of the SNF Jan 1, 2025
Misty Dawn Reid Individual Operational/Managerial Control Jan 2, 2025
Managing Control - Governing BodyVoting Member Jun 1, 2025
Adp of the SNF Jan 2, 2025
Organization, West Hills, CA LLC, Medical provider/supplier, For-profit Adp of the SNF Apr 8, 2026
Carrie Vanderzanden Individual Managing Control - Governing BodyVoting Member Jun 1, 2025
Adp of the SNF Jan 1, 2025
Organization, Tustin, CA LLC, Holding company, For-profit 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.

Facilities with the same owner 26

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 26

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.

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

Verify at the official NPI Registry.