MEDICARE: M.C.L. DAVIS FOUNDATION INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1306796339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.C.L. DAVIS FOUNDATION INCORPORATED

Provider Business Mailing Address
First Line	:	7814 DESPERADO WAY
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-5191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7814 DESPERADO WAY
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-5191
Country	:	US
Telephone Number	:	913-282-3944
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	CARMITA COLLINS
Credential	:
Telephone Number	:	913-282-3944

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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