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General NPI Number Information
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NPI Number | 1588526362
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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 | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1200 N FRENCH ST FL 6
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City | WILMINGTON
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State | DE
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Zip | 19801-3239
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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 | CEO
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Name | FORREST WATSON III
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 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 #3
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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 #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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