# RAVEN LAKE HEALTHCARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TriState Health and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285408401
- **Authorized official:** SOON BURNAM (TREASURER)
- **Authorized official phone:** (949) 540-1249

## Contact information

- **Practice address:** 600 SHAWANEE RD, HARROGATE, TN 37752-8305
- **Practice address phone:** (423) 869-5376
- **Practice address fax:** (423) 869-4107
- **Mailing address:** 600 SHAWANEE RD, HARROGATE, TN 37752-8305
- **Mailing address phone:** (423) 869-5376
- **Mailing address fax:** (423) 869-4107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/08/2023
- **Last updated:** 08/30/2024