Healthcare Provider Details

I. General information

NPI: 1669274452
Provider Name (Legal Business Name): WESTSIDE FAMILY HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N CLAYMONT ST
WILMINGTON DE
19802-2807
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-6800
  • Fax:
Mailing address:
  • Phone: 302-656-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER FRASER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: FACHE
Phone: 302-584-6290