44D0995863 CLIA NUMBER - RAVEN LAKE HEALTHCARE, INC DBA TRISTATE HEALTH AND REHABILITATION CENTER

Laboratory Demographics

  • CLIA Code: 44D0995863
  • Facility Name: RAVEN LAKE HEALTHCARE, INC DBA TRISTATE HEALTH AND REHABILITATION CENTER
  • Facility Address: 600 SHAWANEE ROAD
    HARROGATE, TN
    ZIP 37752
  • Facility Phone: 423 869-5376
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LUIS PANNOCCHIA
  • NPI Number: 1407843030
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 44D0995863
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name RAVEN LAKE HEALTHCARE, INC DBA TRISTATE HEALTH AND REHABILITATION CENTER
Street 600 SHAWANEE ROAD
City HARROGATE
State TN
ZIP 37752
Phone 423 869-5376
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LUIS PANNOCCHIA

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This page was last updated on: 9/29/2025