THE LIFE CENTER COMPLEX INC NPI 1770808578

NPI Information

NPI: 1770808578
Provider Name: THE LIFE CENTER COMPLEX, INC
Classification: Clinic/Center - 261QC1500X
Entity Type: Organization

Specialization: Community Health

Address:
1624 JESSUP ST
WILMINGTON, DE
ZIP 19802
Phone: (302) 552-3574
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THE LIFE CENTER COMPLEX, INC is a community health clinic center in Wilmington, DE. THE LIFE CENTER COMPLEX, INC NPI is 1770808578. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1624 JESSUP ST
WILMINGTON, DE
ZIP 19802-210
Phone: (302) 552-3574
Fax: (302) 552-3561

The provider's authorized official is Forrest Watson .
The authorized official title is President and has the following contact phone number (302) 552-3574.

The enumeration date for this NPI number is 4/5/2010 and was last updated on 3/28/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TP2701X	Psychologist	Group Psychotherapy	71788	DELAWARE	No
2	261QC1500X	Clinic/Center	Community Health		DELAWARE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1770808578	MEDICAID	DELAWARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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