Healthcare Provider Details

I. General information

NPI: 1821949835
Provider Name (Legal Business Name): DUNGARVIN LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 3RD ST
MAMOU LA
70554-4305
US

IV. Provider business mailing address

1444 NORTHLAND DR STE 200
MENDOTA HEIGHTS MN
55120-1032
US

V. Phone/Fax

Practice location:
  • Phone: 651-699-0206
  • Fax:
Mailing address:
  • Phone: 651-699-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LORI KRESS
Title or Position: CEO
Credential:
Phone: 651-789-5906