Healthcare Provider Details

I. General information

NPI: 1316076268
Provider Name (Legal Business Name): MICHAEL DUNN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 GALLAHER RD
KINGSTON TN
37763-4215
US

IV. Provider business mailing address

629 GALLAHER RD
KINGSTON TN
37763-4215
US

V. Phone/Fax

Practice location:
  • Phone: 865-376-3416
  • Fax: 865-717-4858
Mailing address:
  • Phone: 865-376-3416
  • Fax: 865-717-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 10
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 11
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 12
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 13
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 14
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberL 3(20)4M5-056-1346
License Number StateTN
# 15
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberL 3(20)4M5-056-1346
License Number StateTN

VIII. Authorized Official

Name: MR. MIKE MCELHINNEY
Title or Position: PRESIDENT CEO
Credential:
Phone: 865-376-3416