# DUNGARVIN INDIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DUNGARVIN GROUP, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275743205
- **Legal business name:** DUNGARVIN GROUP, INC.
- **Authorized official:** LORI KRESS (CEO)
- **Authorized official phone:** (651) 699-0206

## Contact information

- **Practice address:** 3575 MOREAU CT STE 200, SOUTH BEND, IN 46628-4387
- **Practice address phone:** (574) 245-5400
- **Practice address fax:** (574) 245-5440
- **Mailing address:** 1444 NORTHLAND DR STE 200, MENDOTA HEIGHTS, MN 55120-1032
- **Mailing address phone:** (651) 699-0206
- **Mailing address fax:** (651) 699-0799

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | — | — | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | — | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | — | — |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 04/27/2023

## 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 |