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Residential Treatment Facilities Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities

Provider NPI: 1275743205

Organization Information:
Organization Name:  DUNGARVIN INDIANA, LLC
Organization is Subpart
Authorized Official:  TIM  MADDEN  CEO  651-699-0206

Practice Location:
Tel: 574-245-5400  Fax: 574-245-5440

Business Mailing Address:
Tel: 651-699-0206  Fax: 651-699-0799

NPI Information:
NPI: 1275743205
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N320900000XResidential Treatment Facilities
Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities
N315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
Y320600000XResidential Treatment Facilities
Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 320600000X





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