Provider Demographics
NPI:1750267027
Name:THE LIFE CENTER COMPLEX, INC
Entity type:Organization
Organization Name:THE LIFE CENTER COMPLEX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:302-407-5316
Mailing Address - Street 1:812 PHILADELPHIA PIKE STE F
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2371
Mailing Address - Country:US
Mailing Address - Phone:302-407-5316
Mailing Address - Fax:
Practice Address - Street 1:812 PHILADELPHIA PIKE STE F
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2371
Practice Address - Country:US
Practice Address - Phone:302-407-5316
Practice Address - Fax:302-407-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty