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
—
—
Other
Enumeration date
11/08/2023
Last updated
08/30/2024
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