=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306796339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M.C.L. DAVIS FOUNDATION INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2026
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7814 DESPERADO WAY
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78015-5191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-282-3944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7814 DESPERADO WAY
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78015-5191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | CARMITA COLLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-282-3944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------