Healthcare Provider Details

I. General information

NPI: 1023508322
Provider Name (Legal Business Name): FIRST STATE EMPLOYMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 HARLAN BLVD
WILMINGTON DE
19801-5166
US

IV. Provider business mailing address

524 HARLAN BLVD
WILMINGTON DE
19801-5166
US

V. Phone/Fax

Practice location:
  • Phone: 302-250-5883
  • Fax: 302-984-3329
Mailing address:
  • Phone: 302-250-5883
  • Fax: 302-984-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CLINTON GANGLOFF
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 302-383-0191