Organization Active NPI

CG-Dsa, LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Shelbyville, IN
National Provider Identifier
1962438671
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
CG-DSA, LLC
Practice address
2326 Berwick Drive
Shelbyville, IN 46176-3125
Phone
(317) 477-0093
Fax
(317) 348-3430
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anna Todd
Title
Operations Business Manager
Phone
(800) 299-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

2326 Berwick Drive
Shelbyville, IN 46176-3125

Mailing address

4800 Overton Plaza
Suite 400
Fort Worth, TX 76109-4435
Phone (800) 299-5161

Other identifiers 1

IdentifierTypeStateIssuer
100234640CMedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
CG-Dsa LLC41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Locations

4800 Overton Plz
Ste 400
Fort Worth, TX 76109

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628812800000",
    "number": "1962438671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 OVERTON PLAZA",
            "address_2": "SUITE 400",
            "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": "2326 BERWICK DRIVE",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461763125",
            "telephone_number": "317-477-0093",
            "fax_number": "317-348-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CG-DSA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "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": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100234640C",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.