Provider Demographics
NPI:1225248677
Name:DUNGARVIN ALABAMA LLC
Entity Type:Organization
Organization Name:DUNGARVIN ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-444-1617
Mailing Address - Street 1:400 LEGACY PLZ W
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5296
Mailing Address - Country:US
Mailing Address - Phone:219-326-6277
Mailing Address - Fax:219-362-5498
Practice Address - Street 1:3941 LORNA RD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1030
Practice Address - Country:US
Practice Address - Phone:205-444-1617
Practice Address - Fax:205-444-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities