NPIMap

Organization Active NPI

Michael Dunn Center

  • Intellectual Disabilities Intermediate Care Facility
  • Kingston, TN
National Provider Identifier
1003950692
Registry record updated Oct 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
L 323-056-1347 Issued in TN
Legal business name
MICHAEL DUNN CENTER
Practice address
106 Village Trce
Kingston, TN 37763-7066
Phone
(865) 376-3416
Fax
(865) 717-4858
NPI assigned
Feb 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2011

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

Authorized official

Name
Ms. Tracey Taylor
Title
Residential Accountant
Phone
(865) 376-3416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X L 323-056-1347 TN Primary

Addresses

Primary practice location

106 Village Trce
Kingston, TN 37763-7066

Mailing address

629 Gallaher Rd
Kingston, TN 37763-4215
Phone (865) 376-3416

Other identifiers 1

IdentifierTypeStateIssuer
7447111MedicaidTN

Other names 1

  • Julia Caillouette Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Michael Dunn Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1003950692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 GALLAHER RD",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377634215",
            "telephone_number": "865-376-3416",
            "fax_number": "865-717-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 VILLAGE TRCE",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377637066",
            "telephone_number": "865-376-3416",
            "fax_number": "865-717-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL DUNN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "RESIDENTIAL ACCOUNTANT",
        "authorized_official_telephone_number": "865-376-3416",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TN",
            "license": "L 323-056-1347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7447111",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Julia Caillouette Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kingston, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.