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Organization Active NPI

Dungarvin Indiana, LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • South Bend, IN
National Provider Identifier
1275743205
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
DUNGARVIN INDIANA, LLC
Practice address
3575 Moreau CT Ste 200
South Bend, IN 46628-4387
Phone
(574) 245-5400
Fax
(574) 245-5440
NPI assigned
May 22, 2007
Last updated
Apr 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
DUNGARVIN GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori Kress
Title
Ceo
Phone
(651) 699-0206

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X

Addresses

Primary practice location

3575 Moreau CT Ste 200
South Bend, IN 46628-4387

Mailing address

1444 Northland Dr Ste 200
Mendota Heights, MN 55120-1032
Phone (651) 699-0206

Other identifiers 9

IdentifierTypeStateIssuer
100239960MedicaidIN
100245120MedicaidIN
100245230MedicaidIN
100244770MedicaidIN
100244780MedicaidIN
100239800MedicaidIN
100244830MedicaidIN
100244950MedicaidIN
100230070MedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Dungarvin Indiana LLC63 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3570 Blackthorn Ct
South Bend, IN 46628
Phone (219) 234-8631

3575 Moreau Ct
Ste 200
South Bend, IN 46628
Phone (219) 248-3666

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1275743205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1444 NORTHLAND DR STE 200",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201032",
            "telephone_number": "651-699-0206",
            "fax_number": "651-699-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3575 MOREAU CT STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466284387",
            "telephone_number": "574-245-5400",
            "fax_number": "574-245-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUNGARVIN INDIANA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DUNGARVIN GROUP, INC.",
        "enumeration_date": "2007-05-22",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "KRESS",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-699-0206"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100239960",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100245120",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100245230",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244770",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244780",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100239800",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244830",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244950",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100230070",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.