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
1538 N STATE ST, GREENFIELD, IN 46140-1060
(317) 477-0093
Mailing address
4800 OVERTON PLZ STE 440, FORT WORTH, TX 76109-4435
(800) 299-5161
(817) 447-3033
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/09/2018
Last updated
05/03/2021
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