Davidson Marie Lane LLC.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

DAVIDSON MARIE LANE LLC.

Practice address

2834 Marie LN
Merced, CA 95340-2611

Phone

(916) 225-0349

NPI assigned

Mar 13, 2021

Organization subpart

No

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

Authorized official

Name

Godwin Aka

Title

Ceo

Phone

(916) 225-0349

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 05G467

Legal name

DAVIDSON HOME - MARIE LANE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Sep 12, 1990

Last certification

Mar 13, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

2834 Marie LN
Merced, CA 95340

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

{
    "created_epoch": "1615593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615593600000",
    "number": "1033794805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8194 SUNRISE BLVD",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956101535",
            "telephone_number": "916-727-9127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2834 MARIE LN",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953402611",
            "telephone_number": "916-225-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIDSON MARIE LANE LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-13",
        "last_updated": "2021-03-13",
        "certification_date": "2021-03-13",
        "status": "A",
        "authorized_official_last_name": "AKA",
        "authorized_official_first_name": "GODWIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-225-0349"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ife@citruscg.com",
            "affiliation": "Y",
            "endpointDescription": "email",
            "affiliationName": "Citrus Care Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2834 Marie Ln",
            "city": "Merced",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953402611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Davidson Adult Home / Brookdale Dr
• Davidson Adult Home /Sun Valley CT
• Davidson Brookdale LLC.
• Davidson Childrens Home / Marie LN
• Davidson Donna Drive
• Davidson Sun Valley
• Julie Diane Davidson, FNP
• Kyle Wesley Davidson
• Daniel Robert Davies
• Davis & O'Connor Dental Corporation (Olive Dental Care)

• Intellectual Disabilities Intermediate Care Facility in Merced, CA
• Providers in Merced, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.