Provider Demographics
NPI:1952303695
Name:WESTSIDE FAMILY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:WESTSIDE FAMILY HEALTHCARE, INC.
Other - Org Name:NORTHEAST COMMUNITY HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:302-656-8292
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-0151
Mailing Address - Country:US
Mailing Address - Phone:302-655-5822
Mailing Address - Fax:
Practice Address - Street 1:908 E 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-5145
Practice Address - Country:US
Practice Address - Phone:302-225-1800
Practice Address - Fax:302-225-4526
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE FAMILY HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000356566Medicaid
DE081803Medicare Oscar/Certification
DE081803Medicare PIN