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Organization
RAVEN LAKE HEALTHCARE, INC.
Active
Organization
RAVEN LAKE HEALTHCARE, INC.
Active
Other names
TriState Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
SOON BURNAM (TREASURER)
(949) 540-1249
Entity
Organization
Contact information
Practice address
600 SHAWANEE RD, HARROGATE, TN 37752-8305
(423) 869-5376
(423) 869-4107
Mailing address
600 SHAWANEE RD, HARROGATE, TN 37752-8305
(423) 869-5376
(423) 869-4107
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Enumeration date
11/08/2023
Last updated
08/30/2024
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