MEDICARE: THE LIFE CENTER COMPLEX, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	2083P0901X	Public Health & General Preventive Medicine Physician
3	363LF0000X	Family Nurse Practitioner
4	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1225971518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LIFE CENTER COMPLEX, INC

Provider Business Mailing Address
First Line	:	812 PHILADELPHIA PIKE STE F
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-2371
Country	:	US
Telephone Number	:	302-407-5316
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 SALEM CHURCH RD
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2938
Country	:	US
Telephone Number	:	302-407-5316
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FORREST WATSON III
Credential	:
Telephone Number	:	302-407-5316

Provider Enumeration Date	:	04/11/2026
Last Update Date	:	04/11/2026

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