The Life Center Complex, Inc.

Primary specialty

Student Health Clinic/CenterTaxonomy code 261QS1000X

Legal business name

THE LIFE CENTER COMPLEX, INC.

Practice address

629 Buckson Dr
Dover, DE 19901-2503

Phone

(302) 407-5316

NPI assigned

Oct 4, 2022

Organization subpart

No

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

Authorized official

Name

Forrest Watson

Title

Ceo

Phone

(302) 552-3574

Specialties & licenses 1

Addresses

Other names 1

• Life Health @ Towne Point Doing business as

Medicare fee-for-service enrollment

Enrolled in DE

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • Wilmington, DE
  • NPI 1366114522

  O20130819000252

  Same enrollment
• The Life Center Complex, Inc

  • Community Health Clinic/Center
  • Wilmington, DE
  • NPI 1770808578

  O20130819000252

  Same enrollment

Tax ID family

The Life Center Complex Inc32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • Wilmington, DE
  • NPI 1013586106
  NPD tax ID
• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • New Castle, DE
  • NPI 1043798366
  NPD tax ID
• The Life Center Complex, Inc

  • General Practice Physician
  • Dover, DE
  • NPI 1124961412
  NPD tax ID
• The Life Center Complex, Inc

  • General Practice Physician
  • New Castle, DE
  • NPI 1144163437
  NPD tax ID
• The Life Center Complex, Inc

  • Family Medicine Physician
  • Wilmington, DE
  • NPI 1144198003
  NPD tax ID
• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • Wilmington, DE
  • NPI 1164315040
  NPD tax ID
• The Life Center Complex, Inc

  • General Practice Physician
  • Newark, DE
  • NPI 1225971518
  NPD tax ID
• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • New Castle, DE
  • NPI 1326611443
  NPD tax ID
• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • New Castle, DE
  • NPI 1346728672
  NPD tax ID
• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • Wilmington, DE
  • NPI 1366114522
  NPD tax ID
• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • New Castle, DE
  • NPI 1427600220
  NPD tax ID
• The Life Center Complex, Inc

  • Student Health Clinic/Center
  • New Castle, DE
  • NPI 1467939082
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carolyn Rena Smith

  • Family Nurse Practitioner
  • Wilmington, DE
  • NPI 1023893393
  NPD

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1609590538",
    "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": "629 BUCKSON DR",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199012503",
            "telephone_number": "302-407-5316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE CENTER COMPLEX, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "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": "CEO",
        "authorized_official_telephone_number": "302-552-3574"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Health @ Towne Point",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Health @ Towne Point",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Student Health Clinic/Center in Dover, DE
• Providers in Dover, DE by specialty
• Student Health Clinic/Center in Delaware

• 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.