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NPI Code Detail

MEDICARE: DUNGARVIN INDIANA, LLC

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
1315P00000XIntellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number : 1619825767
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 : 7085 ALLISONVILLE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-3895
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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