Provider Demographics
NPI:1922584903
Name:DIYA SENIOR CARE CORP
Entity Type:Organization
Organization Name:DIYA SENIOR CARE CORP
Other - Org Name:DIYA SENIOR CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:BANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:408-832-1153
Mailing Address - Street 1:276 CLEARPARK CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2308
Mailing Address - Country:US
Mailing Address - Phone:408-832-1153
Mailing Address - Fax:408-629-0388
Practice Address - Street 1:366 LASSENPARK CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-2159
Practice Address - Country:US
Practice Address - Phone:408-832-1153
Practice Address - Fax:408-832-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4352026083104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherSTATE OF CALIFORNIA
CA=========Medicaid