Healthcare Provider Details

I. General information

NPI: 1134063266
Provider Name (Legal Business Name): DIVE OPPORTUNITY HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 MAYBERRY AVE
RANCHO CUCAMONGA CA
91737-3743
US

IV. Provider business mailing address

7056 ARCHIBALD AVE STE 102-357
CORONA CA
92880-8713
US

V. Phone/Fax

Practice location:
  • Phone: 310-386-7919
  • Fax:
Mailing address:
  • Phone: 310-386-7919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. EBONY MONIQUE MAXIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-386-7919