MEDICARE: DUNGARVIN ALABAMA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1225248677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNGARVIN ALABAMA LLC

Provider Business Mailing Address
First Line	:	400 LEGACY PLZ W
Second Line	:
City	:	LA PORTE
State	:	IN
Zip	:	46350-5296
Country	:	US
Telephone Number	:	219-326-6277
Fax Number	:	219-362-5498

Provider Business Practice Location Address
First Line	:	3941 LORNA RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1030
Country	:	US
Telephone Number	:	205-444-1617
Fax Number	:	205-444-1619

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SANDRA GALLIMORE
Credential	:
Telephone Number	:	205-444-1617

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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