NPIMap

Organization Active NPI

The Life Center Complex, Inc

Doing business as Life Health @ Stubbs

  • Student Health Clinic/Center
  • Wilmington, DE
National Provider Identifier
1366114522
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
THE LIFE CENTER COMPLEX, INC
Doing business as
Life Health @ Stubbs
Practice address
1100 N Pine St
Wilmington, DE 19801-4012
Phone
(302) 552-3574
NPI assigned
Oct 5, 2021
Last updated
Mar 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
THE LIFE CENTER COMPLEX, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Authorized official

Name
Forrest Watson
Title
Executive Director
Phone
(302) 407-5316

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X Primary

Addresses

Primary practice location

1100 N Pine St
Wilmington, DE 19801-4012

Mailing address

812 Philadelphia Pike Ste F
Wilmington, DE 19809-2371
Phone (302) 407-5316

Other names 1

  • Life Health @ Stubbs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130819000252 DE Part B Supplier - Clinic/Group Practice 6800038076 Receives reassigned benefits from 8 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dover, DE; Wilmington, DE

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
The Life Center Complex Inc32 organizations share this tax ID, including this one
Part of
The Life Center Complex Inc

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

629 Buckson Dr
Dover, DE 19901
Phone (302) 672-1592

222 Philadelphia Pike
Ste 13
Wilmington, DE 19809
Phone (302) 762-6864

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1366114522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 PHILADELPHIA PIKE STE F",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198092371",
            "telephone_number": "302-407-5316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N PINE ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198014012",
            "telephone_number": "302-552-3574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE CENTER COMPLEX, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE LIFE CENTER COMPLEX, INC",
        "enumeration_date": "2021-10-05",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "FORREST",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "302-407-5316"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Health @ Stubbs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Health @ Stubbs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.