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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