CG-Dsa, LLC
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Crawfordsville, IN
NPI 1154340396 · NPPES record last updated Aug 13, 2021
Key facts
- NPI
- 1154340396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Legal business name
- CG-DSA, LLC
- Practice address
- 1313 Homewood Drive
Crawfordsville, IN 47933-3341 - Phone
- (765) 362-0905
- NPI assigned
- Jul 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Anna Todd
- Title
- Operations Business Manager
- Phone
- (800) 299-5161
Corporate family (same tax ID) 40
Practitioners 1
National Provider Directory
- Tax ID family
- CG-Dsa LLC
Locations
1313 Homewood Ave
Crawfordsville, IN 47933
Phone (765) 362-0905
4800 Overton Plz
Fort Worth, TX 76109
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 0683I0001JN08 | IN | |
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 0683I0002JN08 | IN | |
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 0683I0003JN08 | IN | |
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 0683I0004JN08 | IN | |
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 0683I0005JN08 | IN | |
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
1313 Homewood Drive
Crawfordsville, IN 47933-3341
Mailing address
4800 Overton Plaza
Fort Worth, TX 76109-4435
Phone (800) 299-5161
NPI Registry JSON
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1628812800000",
"number": "1154340396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4800 OVERTON PLAZA",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761094435",
"telephone_number": "800-299-5161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 HOMEWOOD DRIVE",
"city": "CRAWFORDSVILLE",
"state": "IN",
"postal_code": "479333341",
"telephone_number": "765-362-0905"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CG-DSA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-19",
"last_updated": "2021-08-13",
"certification_date": "2021-08-13",
"status": "A",
"authorized_official_last_name": "TODD",
"authorized_official_first_name": "ANNA",
"authorized_official_title_or_position": "OPERATIONS BUSINESS MANAGER",
"authorized_official_telephone_number": "800-299-5161"
},
"taxonomies": [
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": "IN",
"license": "0683I0001JN08",
"primary": false
},
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": "IN",
"license": "0683I0002JN08",
"primary": false
},
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": "IN",
"license": "0683I0003JN08",
"primary": false
},
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": "IN",
"license": "0683I0004JN08",
"primary": false
},
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": "IN",
"license": "0683I0005JN08",
"primary": false
},
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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All providers in Crawfordsville, IN · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.