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
227 GASLITE LANE, GREENFIELD, IN 46140-1012
(765) 649-4247
(765) 642-8512
Mailing address
4800 OVERTON PLAZA, SUITE 440, FORT WORTH, TX 76109-4435
(800) 299-5161
(317) 462-1250
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100248830C
—
IN
Enumeration date
07/04/2006
Last updated
08/17/2021
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