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Organization
TRI STATE MANOR, LLC
Active
Organization
TRI STATE MANOR, LLC
Active
Other names
Tri State Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. W STEWART SWAIN CFO (OWNER- FINANCIAL OFFICER)
(843) 449-0215
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
0000000038
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445263
—
TN
05
—
7440543
—
TN
Enumeration date
09/29/2005
Last updated
04/27/2015
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