Healthcare Provider Details

I. General information

NPI: 1093623613
Provider Name (Legal Business Name): DIVINE SENIOR CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BROMMER ST
SANTA CRUZ CA
95062-3049
US

IV. Provider business mailing address

101 E VINEYARD AVE STE 119-220
LIVERMORE CA
94550-6374
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-6366
  • Fax: 831-462-9312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANSHU GUPTA
Title or Position: ADMINISTRATOR
Credential:
Phone: 831-212-3178