Organization Active NPI

La Main Divine Inc

  • Developmentally Disabled Services Day Training Agency
  • Clermont, FL
National Provider Identifier
1639048366
Registry record updated Oct 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
LA MAIN DIVINE INC
Practice address
1521 Sundown LN
Clermont, FL 34711-2793
Phone
(352) 988-9276
NPI assigned
Oct 31, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alica Charles, CEO
Title
Administrator
Phone
(352) 988-9276

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Physical Disabilities Residential Treatment Facility 320700000X

Addresses

Primary practice location

1521 Sundown LN
Clermont, FL 34711-2793

Mailing address

1521 Sundown LN
Clermont, FL 34711-2793
Phone (352) 988-9276

Other identifiers 1

IdentifierTypeStateIssuer
0138872MedicaidFL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761868800000",
    "number": "1639048366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 SUNDOWN LN",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112793",
            "telephone_number": "352-988-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 SUNDOWN LN",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112793",
            "telephone_number": "352-988-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA MAIN DIVINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-31",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "ALICA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "352-988-9276",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0138872",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.