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DUNGARVIN INDIANA, LLC
NPI 1275743205
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in South Bend, IN

Active since May 22, 2007CLIA 15D2036019 · Waiver
3575 MOREAU CT STE 200, SOUTH BEND, IN 46628(574) 245-5400(574) 245-5440 Get Directions Write a Review

NPPES record last updated: April 27, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dungarvin Indiana, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DUNGARVIN INDIANA, LLC (NPI 1275743205) is a healthcare organization registered as a residential treatment facility, intellectual and/or developmental disabilities in South Bend, Indiana and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through January 29, 2028 and lists Lori Kress, Ceo, as its authorized official.

NPPES Registry Identity

NPI1275743205
Entity TypeOrganization
Primary Taxonomy320600000X
Legal Business NameDUNGARVIN INDIANA, LLC
Location Address3575 MOREAU CT STE 200South Bend, IN 46628-4387
Mailing Address1444 Northland Dr Ste 200Mendota Heights, MN 55120-1032 · (651) 699-0206 · Fax (651) 699-0799
Phone(574) 245-5400
Fax(574) 245-5440
Organization SubpartYesParent: Dungarvin Group, Inc.
Authorized OfficialLori KressCeo · (651) 699-0206
Enumeration DateMay 22, 2007
Last NPPES UpdateApril 27, 2023
NPPES CertifiedApril 27, 2023
✔ NPI 1275743205 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320600000X
Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

Also ListedIntermediate Care Facility, Intellectual DisabilitiesTaxonomy 315P00000X
Also ListedCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesTaxonomy 320900000X
3575 MOREAU CT STE 200, South Bend, IN 46628
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Other Identifiers 9

Medicaid100239960IN
Medicaid100245120IN
Medicaid100245230IN
Medicaid100244770IN
Medicaid100244780IN
Medicaid100239800IN
Medicaid100244830IN
Medicaid100244950IN
Medicaid100230070IN

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2036019

Dungarvin Indiana LLC · South Bend, IN
Active · expires Jan 29, 2028
CLIA Number15D2036019
Laboratory TypeAssisted Living Facility
Certificate Effective DateJanuary 30, 2026
Certificate Expiration DateJanuary 29, 2028
Laboratory DirectorRick Adams
Laboratory Phone(574) 245-5400
Laboratory LocationDungarvin Indiana LLC3521 Oxford Lane, South Bend, IN 46615
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TRACIE M NAILLIEUX
Registered Nurse
3575 MOREAU CT STE 200
SOUTH BEND, IN 46628
St. Joseph County (219) 248-3666

Frequently Asked Questions

What is DUNGARVIN INDIANA, LLC's NPI number?

The NPI number assigned to this healthcare provider is 1275743205, enumerated as an "organization" on May 22, 2007.

Where is the provider located?

The provider is located at 3575 MOREAU CT STE 200 SOUTH BEND, IN 46628 and the phone number is (574) 245-5400.

What is the provider's specialty?

Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

What insurance does DUNGARVIN INDIANA, LLC accept?

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.