Provider Demographics
NPI:1588706022
Name:DEVELOPMENTAL SERVICES OF DICKSON COUNTY, INC.
Entity type:Organization
Organization Name:DEVELOPMENTAL SERVICES OF DICKSON COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-446-3111
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37056-0628
Mailing Address - Country:US
Mailing Address - Phone:615-446-3111
Mailing Address - Fax:615-446-1846
Practice Address - Street 1:115 LUTHER RD
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2112
Practice Address - Country:US
Practice Address - Phone:615-446-3111
Practice Address - Fax:615-446-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-438-045-913251C00000X
TNPSS0000000018251J00000X
TNL000000008440253J00000X, 252Y00000X, 385H00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No253J00000XAgenciesFoster Care Agency
No252Y00000XAgenciesEarly Intervention Provider Agency
No385H00000XRespite Care FacilityRespite Care