Davidson Adult Home /Sun Valley CT

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

LTC70715F Issued in CA

Legal business name

DAVIDSON ADULT HOME /SUN VALLEY CT

Practice address

48 Sun Valley CT
Merced, CA 95348-3017

Phone

(209) 384-7402

Fax

(209) 383-1538

NPI assigned

Sep 26, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Julie Diane Davidson, RN

Title

Owner

Phone

(209) 384-7402

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190764800000",
    "number": "1841487550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 332",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953410332",
            "telephone_number": "209-384-7402",
            "fax_number": "209-383-1538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 SUN VALLEY CT",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953483017",
            "telephone_number": "209-384-7402",
            "fax_number": "209-383-1538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIDSON ADULT HOME /SUN VALLEY CT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2007-09-26",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-384-7402",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "LTC70715F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60772F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Hatton Davenport III
• David J. Riordan'S Hobie House
• Marie Pasion David, MD
• Alejandro Davidenko
• Davidson Adult Home / Brookdale Dr
• Davidson Brookdale LLC.
• Davidson Childrens Home / Marie LN
• Davidson Donna Drive
• Davidson Marie Lane LLC.
• Davidson Sun Valley

• 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 Sep 26, 2007; 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.