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Organization
MICHAEL DUNN CENTER
Active
Organization
MICHAEL DUNN CENTER
Active
Other names
MDC Leda Herron Home
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY TAYLOR (RESIDENTIAL ACCOUNTANT)
(865) 376-3416
Entity
Organization
Contact information
Practice address
104 VILLAGE TRCE, KINGSTON, TN 37763-7066
(865) 376-3416
(865) 717-4858
Mailing address
629 GALLAHER RD, KINGSTON, TN 37763-4215
(865) 376-3416
(865) 717-4858
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
L 323-056-1349
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7447112
—
TN
Enumeration date
03/05/2007
Last updated
10/27/2011
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