Organization
CG-DSA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA TODD (OPERATIONS BUSINESS MANAGER)
(800) 299-5161
Entity
Organization
Contact information
Practice address
1313 HOMEWOOD DRIVE, CRAWFORDSVILLE, IN 47933-3341
(765) 362-0905
Mailing address
4800 OVERTON PLAZA, FORT WORTH, TX 76109-4435
(800) 299-5161
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
0683I0001JN08
IN
315P00000X
Intellectual Disabilities Intermediate Care Facility
0683I0002JN08
IN
315P00000X
Intellectual Disabilities Intermediate Care Facility
0683I0003JN08
IN
315P00000X
Intellectual Disabilities Intermediate Care Facility
0683I0004JN08
IN
315P00000X
Intellectual Disabilities Intermediate Care Facility
0683I0005JN08
IN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/19/2006
Last updated
08/13/2021
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