MEDICARE: DUNGARVIN INDIANA, 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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1609724749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNGARVIN INDIANA, 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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 WARREN DR
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-2122
Country	:	US
Telephone Number	:	651-699-0206
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LORI KRESS
Credential	:
Telephone Number	:	651-789-5906

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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