THE LIFE CENTER COMPLEX, INC (NPI# 1770808578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770808578 |
| Entity Type | Organization |
| Organization Name | THE LIFE CENTER COMPLEX, INC |
| Practice Address |
1624 Jessup St Wilmington DE 19802-4210 |
| Mailing Address |
222 Philadelphia Pike Suite 4 Wilmington DE 19809-3166 |
| Practice Telephone | 3025523574 |
| Practice Fax Number | 3025523561 |
| Mailing Telephone | 3025523574 |
| Mailing Fax Number | 3025523561 |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2015-08-27 |
| Authorized Official Name | MR. FORREST WATSON III (PRESIDENT) |
| Authorized Official Telephone | 3025523574 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TP2701X |
Psychologist Specialization: Group Psychotherapy |
71788 | DE | Behavioral Health & Social Service Providers |
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
DE | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DE | 1770808578 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811475148 | The Life Center Complex, Inc | Clinic/Center | 502 Moores Ln, New Castle, DE 19720-3469 | 2018-07-30 |
| 1043798366 | The Life Center Complex, Inc | Clinic/Center | 16 Pleasant Pl, New Castle, DE 19720-3005 | 2018-07-30 |
| 1700364031 | The Life Center Complex, Inc | Clinic/Center | 903 Delaware St, New Castle, DE 19720-6029 | 2018-07-30 |
| 1861970188 | The Life Center Complex, Inc | Clinic/Center | 1201 Delaware St, New Castle, DE 19720-6057 | 2018-07-30 |
| 1346728672 | The Life Center Complex, Inc | Clinic/Center | 200 E Roosevelt Ave, New Castle, DE 19720-3316 | 2018-07-30 |
| 1467939082 | The Life Center Complex, Inc | Clinic/Center | 27 Landers Ln, New Castle, DE 19720-2022 | 2018-07-26 |
| 1669012993 | The Life Center Complex, Inc | Clinic/Center | 700 N Lombard St, Wilmington, DE 19801-4217 | 2020-01-15 |
| 1427600220 | The Life Center Complex, Inc | Clinic/Center | 12 Landers Ln, New Castle, DE 19720-2023 | 2019-07-11 |
| Street Address |
1624 JESSUP ST |
| City | WILMINGTON |
| State | DE |
| Zip Code | 19802-4210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215583158 | Shanika H. Sanchez | Social Worker | 1624 Jessup St, Wilmington, DE 19802-4210 | 2019-08-15 |
| 1205144060 | Shariyfa Aziyza Fields | Counselor | 1624 Jessup St, Wilmington, DE 19802-4210 | 2010-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457828352 | Allison Porter Nast | Nurse Practitioner | 1624 N Jessup Street, Wilmington, DE 19802 | 2018-10-29 |
| 1851804694 | Laura Jean Cornelis | Nurse Practitioner | 908b East 16th Street, Wilmington, DE 19802 | 2017-11-15 |
| 1477094365 | Jennifer Burris | Nurse Practitioner | 908-b East 16th Street, Wilmington, DE 19802 | 2017-03-13 |
| 1245694694 | Rochelle L Johnson | Counselor | 2005 Baynard Boulevard, Wilmington, DE 19802 | 2016-04-12 |
| 1942674692 | Barbara G Goldsmith | Social Worker | 501 W 37th St, Wilmington, DE 19802 | 2015-11-18 |
| 1942590492 | Olalekan David Falade | Pharmacist | 602 C4 West Lea Blvd, Wilmington, DE 19802 | 2011-04-18 |
| 1598919144 | Trina Brooks Haywood | Registered Nurse | 700 W Lea Blvd Ste 201, Wilmington, DE 19802 | 2008-11-10 |
| 1184808347 | Dr Lesly Robinson Dpm | Podiatrist | 4011 N Market Street, Wilmington, DE 19802 | 2007-12-24 |
| 1366622110 | Overbrook Therapy Associates | Community/Behavioral Health | 1015 West 24th Street, Wilmington, DE 19802 | 2007-11-09 |
| 1215059332 | Everett T Dickerson | Counselor | 620 W 27th St, Wilmington, DE 19802 | 2007-04-06 |
| Find all providers in zip 19802 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
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| 1174144083 | Ubuntu Black Family Wellness Collective | Clinic/Center | 2611 Governor Printz Blvd, Wilmington, DE 19802-4518 | 2020-05-01 |
| 1023536992 | Behavioral Health Services Inc. | Clinic/Center | 1334 N Avalon Blvd, Wilmington, CA 90744-2639 | 2017-08-31 |
| 1801154463 | Total Care Medical Clinic Inc | Clinic/Center | 1110 W Anaheim St, Suite 6, Wilmington, CA 90744-4131 | 2012-05-01 |
| 1386171767 | Reflections of Hope, L.l.p. | Clinic/Center | 33 Darlington Ave, Wilmington, NC 28403-1343 | 2017-05-17 |
| 1750694170 | Coastal Nutrition, LLC | Clinic/Center | 1612 Doctors Cir, Wilmington, NC 28401-7406 | 2010-07-15 |
| 1093843385 | New Hanover County | Clinic/Center | 2029 S 17th St, Wilmington, NC 28401-6600 | 2007-03-01 |
| 1235286667 | Nationwide Medical Group, Inc | Clinic/Center | 1322 N Avalon Blvd, Wilmington, CA 90744-2639 | 2007-01-05 |
| 1093814907 | Wilmington Community Clinic | Clinic/Center | 1009 N Avalon Blvd, Wilmington, CA 90744-4505 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145262 | The Natural Hypertension Institute Inc | Clinic/Center | 207 Sutton Way, Newark, DE 19711-3244 | 2020-05-11 |
| 1104164524 | Christianacare Health Systems | Clinic/Center | 100 Sunnyside Rd 3rd Floor Prickett South, Smyrna, DE 19977 | 2013-01-18 |
| 1841680147 | La Red Health Center | Clinic/Center | 21444 Carmean Way, Georgetown, DE 19947-4572 | 2015-01-26 |
| 1023455383 | Walgreens 11079 | Clinic/Center | 38627 Benro Dr, Delmar, DE 19940-3572 | 2013-05-28 |
| 1790716363 | Greenwood Urgent Care Center Inc | Clinic/Center | 640 S Queen St, Dover, DE 19904-3565 | 2006-07-05 |
| City | WILMINGTON |
| Zip Code | 19802 |
Please comment or provide details below to improve the information on THE LIFE CENTER COMPLEX, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.