Tri State Manor, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0000000038 Issued in TN

Legal business name

TRI STATE MANOR, LLC

Doing business as

Tri State Health and Rehabilitation Center

Practice address

600 Shawanee Rd
Harrogate, TN 37752-8305

Phone

(423) 869-5376

Fax

(423) 869-4107

NPI assigned

Sep 29, 2005

Last updated

Apr 27, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. W Stewart Swain, CFO

Title

Owner- Financial Officer

Phone

(843) 449-0215

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Tri State Health and Rehabilitation Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Luis C Pannocchia, M.D.

  • Family Medicine Physician
  • New Tazewell, TN
  • NPI 1912988965
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1407843030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 SHAWANEE RD",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377528305",
            "telephone_number": "423-869-5376",
            "fax_number": "423-869-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SHAWANEE RD",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377528305",
            "telephone_number": "423-869-5376",
            "fax_number": "423-869-4107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "SWAIN",
        "authorized_official_first_name": "W",
        "authorized_official_middle_name": "STEWART",
        "authorized_official_title_or_position": "OWNER- FINANCIAL OFFICER",
        "authorized_official_telephone_number": "843-449-0215",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440543",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445263",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri State Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Teagan Trent
• Charlton C Vass, L.M.T./N.M.T.
• Frank Joseph Venuti, M.D.
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• Mallory Elisha Vinsant, PA-C
• Tyler Webb

• Skilled Nursing Facility in Harrogate, TN
• Providers in Harrogate, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.