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NPI Code Detail

MEDICARE: DUNGARVIN OKLAHOMA LLC

MEDICARE: DUNGARVIN OKLAHOMA 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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility100631340DOK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100631340DOTHEROKOHCA PROVIDER ID

General Provider Information

NPI Number : 1356416028
Entity Type Code : Organization
Provider Name (Legal Business Name) : DUNGARVIN OKLAHOMA LLC
Provider Business Mailing Address
First Line : 1444 NORTHLAND DR STE 200
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1032
Country : US
Telephone Number : 651-699-0206
Fax Number : 651-699-0799
Provider Business Practice Location Address
First Line : 9210 S WESTERN AVE STE A-22
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-4982
Country : US
Telephone Number : 405-759-2611
Fax Number : 405-759-2650
Authorized Official
Title or Position : CEO
Name : LORI KRESS
Credential :
Telephone Number : 651-699-0206
Provider Enumeration Date : 11/21/2006
Last Update Date : 04/27/2023

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Directions to “DUNGARVIN OKLAHOMA LLC ” Practice Location

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