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General NPI Number Information
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NPI Number | 1164315040
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Entity Type | Organization
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Legal Business Name | THE LIFE CENTER COMPLEX, INC
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 3707 N MARKET ST
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City | WILMINGTON
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State | DE
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Zip | 19802-2213
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Country | US
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Telephone | 302-407-5316
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Fax |
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Provider Business Mailing Address
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Address Line | 812 PHILADELPHIA PIKE STE F
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City | WILMINGTON
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State | DE
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Zip | 19809-2371
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Country | US
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Telephone | 302-407-5316
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Fax |
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Authorized Official
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Title or Position | OPERATIONS COORDINATOR
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Name | MS. KIM PURNELL
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Credential |
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Telephone | 302-407-5316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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