TRISTATE HEALTH AND REHABILITATION CENTER
NPI 1285408401
Skilled Nursing Facility in Harrogate, TN

Active since November 08, 2023CLIA 44D0995863 · Waiver
600 SHAWANEE RD, HARROGATE, TN 37752(423) 869-5376(423) 869-4107 Get Directions Write a Review

NPPES record last updated: August 30, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Tristate Health And Rehabilitation Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRISTATE HEALTH AND REHABILITATION CENTER (NPI 1285408401) is a healthcare organization registered as a skilled nursing facility in Harrogate, Tennessee and active in the NPI registry since November 2023. The organization holds a CLIA Waiver certificate valid through January 31, 2028 and lists Soon Burnam, Treasurer, as its authorized official.

NPPES Registry Identity

NPI1285408401
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameRAVEN LAKE HEALTHCARE, INC.
Location Address600 SHAWANEE RDHarrogate, TN 37752-8305
Mailing Address600 Shawanee RdHarrogate, TN 37752-8305 · (423) 869-5376 · Fax (423) 869-4107
Fax(423) 869-4107
Organization SubpartNo
Authorized OfficialSoon BurnamTreasurer · (949) 540-1249
Enumeration DateNovember 8, 2023
Last NPPES UpdateAugust 30, 2024
NPPES CertifiedAugust 30, 2024
NPI 1285408401 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
600 SHAWANEE RD, Harrogate, TN 37752

Other Names 1

Doing Business AsTristate Health And Rehabilitation Center

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D0995863

Raven Lake Healthcare, Inc Dba Tristate Health And Rehabilitation Center · Harrogate, TN
Active · expires Jan 31, 2028
CLIA Number44D0995863
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateFebruary 1, 2026
Certificate Expiration DateJanuary 31, 2028
Laboratory DirectorLuis Pannocchia
Laboratory Phone(423) 869-5376
Laboratory LocationRaven Lake Healthcare, Inc Dba Tristate Health And Rehabilitation Center600 Shawanee Road, Harrogate, TN 37752
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapy Assistant
600 SHAWANEE RD
HARROGATE, TN 37752
Speech-Language Pathologist
600 SHAWANEE RD
HARROGATE, TN 37752
Skilled Nursing Facility
600 SHAWANEE RD
HARROGATE, TN 37752

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Raven Lake Healthcare, Inc.'s NPI number?

The NPI number for Raven Lake Healthcare, Inc. is 1285408401. It was assigned to this organization in the NPPES registry on November 8, 2023. The provider is doing business as Tristate Health And Rehabilitation Center.

Where is Raven Lake Healthcare, Inc. located?

Raven Lake Healthcare, Inc. is located at 600 Shawanee Rd, Harrogate, TN 37752. The listed phone number is (423) 869-5376.

What is Raven Lake Healthcare, Inc.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Raven Lake Healthcare, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D0995863) is associated with this NPI, valid through January 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Raven Lake Healthcare, Inc. was last updated on August 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.