MEDICARE: DIVINE BLISS, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)
4	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1144795261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE BLISS, INC.

Provider Business Mailing Address
First Line	:	1219 PARNELL PL
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2737
Country	:	US
Telephone Number	:	954-496-2885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 PARNELL PL
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2737
Country	:	US
Telephone Number	:	714-581-3974
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SERENA GUPTA
Credential	:	PH.D., LMFT
Telephone Number	:	714-606-4012

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	12/09/2024

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Directions to “DIVINE BLISS, INC. ” Practice Location

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