TRI STATE MANOR LLC NPI 1407843030

NPI Information

  • NPI: 1407843030
  • Provider Name: TRI STATE MANOR, LLC
  • Classification: Skilled Nursing Facility - 314000000X
  • Entity Type: Organization
  • Doing Business As: TRI STATE HEALTH AND REHABILITATION CENTER
  • CLIA Number: 44D0995863
  • Address: 600 SHAWANEE RD
    HARROGATE, TN
    ZIP 37752
  • Phone: (423) 869-5376

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NPI Details

TRI STATE MANOR, LLC is a skilled nursing facility in Harrogate, TN. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. TRI STATE MANOR, LLC NPI is 1407843030. The provider is registered as an organization entity type.
The provider Is Doing Business As Tri State Health And Rehabilitation Center.

The provider's business location address is:

600 SHAWANEE RD
HARROGATE, TN
ZIP 37752-305
Phone: (423) 869-5376
Fax: (423) 869-4107

The provider's authorized official is W Stewart Swain .
The authorized official title is Owner- Financial Officer and has the following contact phone number (843) 449-0215.

The CLIA number assigned to this NPI record is 44D0995863 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/29/2005 and was last updated on 4/27/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1314000000XSkilled Nursing Facility0000000038TENNESSEEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1445263MEDICARE OSCAR/CERTIFICATIONTENNESSEE
20445263MEDICAIDTENNESSEE
37440543MEDICAIDTENNESSEE
45135780001MEDICARE NSCFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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