Provider Demographics
NPI:1922683796
Name:DAVIDSON DONNA DRIVE
Entity Type:Organization
Organization Name:DAVIDSON DONNA DRIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-225-0349
Mailing Address - Street 1:8194 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-1535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:916-225-0349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities