NPIMap

Organization Active NPI

The Life Center Complex, Inc

  • Student Health Clinic/Center
  • Wilmington, DE
National Provider Identifier
1669012993
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
Practice address
700 N Lombard St
Wilmington, DE 19801-4217
Phone
(302) 429-4102
Fax
(302) 429-3956
NPI assigned
Jan 15, 2020
Organization subpart
No

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
Mr. Forrest Watson III
Title
Executive Director
Phone
(302) 407-5316

Specialties & licenses 1

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

Addresses

Primary practice location

700 N Lombard St
Wilmington, DE 19801-4217

Mailing address

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

Other names 1

  • The Life Health Center @ Bancroft Doing business as

National Provider Directory

National Provider Directory
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.

View all 31

Locations

700 N Lombard St
Wilmington, DE 19801
Phone (302) 419-7343

NPI Registry JSON

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1669012993",
    "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",
            "fax_number": "302-429-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N LOMBARD ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198014217",
            "telephone_number": "302-429-4102",
            "fax_number": "302-429-3956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE CENTER COMPLEX, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-15",
        "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",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Life Health Center @ Bancroft",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Life Health Center @ Bancroft",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.