Organization
DIVINE LEISURE & ACTIVITY CENTER ,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EMILENES DOMINGUEZ (OWNER)
(786) 413-8657
Entity
Organization
Contact information
Practice address
6500 W 4TH AVE STE 26, HIALEAH, FL 33012-6606
(786) 413-8657
Mailing address
5355 W 7TH CT, HIALEAH, FL 33012-2518
(786) 413-8657
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9482
—
FL
Enumeration date
11/03/2020
Last updated
11/03/2020
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