Organization
LA MAIN DIVINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICA CHARLES CEO (ADMINISTRATOR)
(352) 988-9276
Entity
Organization
Contact information
Practice address
1521 SUNDOWN LN, CLERMONT, FL 34711-2793
(352) 988-9276
Mailing address
1521 SUNDOWN LN, CLERMONT, FL 34711-2793
(352) 988-9276
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0138872
—
FL
Enumeration date
10/31/2025
Last updated
10/31/2025
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