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Organization
DAVIDSON MARIE LANE LLC.
Active
Organization
DAVIDSON MARIE LANE LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GODWIN AKA (CEO)
(916) 225-0349
Entity
Organization
Contact information
Practice address
2834 MARIE LN, MERCED, CA 95340-2611
(916) 225-0349
Mailing address
8194 SUNRISE BLVD, CITRUS HEIGHTS, CA 95610-1535
(916) 727-9127
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
03/13/2021
Last updated
03/13/2021
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