Provider Demographics
NPI:1225614506
Name:LIFE LEARNING CENTER
Entity Type:Organization
Organization Name:LIFE LEARNING CENTER
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:IV
Authorized Official - Credentials:
Authorized Official - Phone:302-300-5519
Mailing Address - Street 1:5 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3235
Mailing Address - Country:US
Mailing Address - Phone:302-300-5519
Mailing Address - Fax:302-552-3561
Practice Address - Street 1:5 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3235
Practice Address - Country:US
Practice Address - Phone:302-300-5519
Practice Address - Fax:302-552-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health