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
2326 BERWICK DRIVE, SHELBYVILLE, IN 46176-3125
(317) 477-0093
(317) 348-3430
Mailing address
4800 OVERTON PLAZA, SUITE 400, FORT WORTH, TX 76109-4435
(800) 299-5161
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
—
100234640C
—
IN
Enumeration date
06/24/2006
Last updated
08/13/2021
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