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Organization
DUNGARVIN INDIANA, LLC
Active
Organization
DUNGARVIN INDIANA, LLC
Active
Parent organization
DUNGARVIN GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
DUNGARVIN GROUP, INC.
Authorized official
LORI KRESS (CEO)
(651) 699-0206
Entity
Organization
Contact information
Practice address
3575 MOREAU CT STE 200, SOUTH BEND, IN 46628-4387
(574) 245-5400
(574) 245-5440
Mailing address
1444 NORTHLAND DR STE 200, MENDOTA HEIGHTS, MN 55120-1032
(651) 699-0206
(651) 699-0799
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100230070
—
IN
05
—
100239800
—
IN
05
—
100239960
—
IN
05
—
100244770
—
IN
05
—
100244780
—
IN
05
—
100244830
—
IN
05
—
100244950
—
IN
05
—
100245120
—
IN
05
—
100245230
—
IN
Enumeration date
05/22/2007
Last updated
04/27/2023
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