Healthcare Provider Details

I. General information

NPI: 1669479929
Provider Name (Legal Business Name): WESTSIDE FAMILY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W 4TH ST
WILMINGTON DE
19805-3420
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-5822
  • Fax: 302-655-5949
Mailing address:
  • Phone: 302-655-2822
  • Fax: 302-655-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER FRASER
Title or Position: PRESIDENT/CEO
Credential: FACHE
Phone: 302-584-6290