Provider Demographics
NPI:1659566511
Name:DONNA DR/ DAVIDSON CHILDRENS HOME
Entity Type:Organization
Organization Name:DONNA DR/ DAVIDSON CHILDRENS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-384-7402
Mailing Address - Street 1:1110 E DONNA DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0678
Mailing Address - Country:US
Mailing Address - Phone:209-384-7402
Mailing Address - Fax:209-383-1538
Practice Address - Street 1:1110 E DONNA DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0678
Practice Address - Country:US
Practice Address - Phone:209-384-7402
Practice Address - Fax:209-383-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities