NPIMap

Organization Active NPI

The Life Center Complex, Inc

Doing business as The Life Health Center @ Edgemont

  • Student Health Clinic/Center
  • Chester, PA
National Provider Identifier
1710725494
Registry record updated Jul 17, 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
The Life Health Center @ Edgemont
Practice address
1350 Edgmont Ave
Chester, PA 19013-3962
Phone
(302) 407-5316
NPI assigned
Jul 17, 2024
Last updated
Jul 17, 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 Jul 17, 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
Ceo
Phone
(302) 407-5316

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Public Health & General Preventive Medicine Physician 2083P0901X NU
General Practice Physician 208D00000X NU
Student Health Clinic/Center 261QS1000X NU Primary

Addresses

Primary practice location

1350 Edgmont Ave
Chester, PA 19013-3962

Mailing address

812 Philadelphia Pike FL 2
Wilmington, DE 19809-2372
Phone (302) 407-5316

Other names 1

  • The Life Health Center @ Edgemont 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
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

812 Philadelphia Pike
Fl 2
Wilmington, DE 19809

NPI Registry JSON

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1710725494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 PHILADELPHIA PIKE FL 2",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198092372",
            "telephone_number": "302-407-5316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 EDGMONT AVE",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "190133962",
            "telephone_number": "302-407-5316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE CENTER COMPLEX, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE LIFE CENTER COMPLEX, INC",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "FORREST",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "302-407-5316",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Life Health Center @ Edgemont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.