Healthcare Provider Details

I. General information

NPI: 1164253589
Provider Name (Legal Business Name): TRISTATE HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N MARKET ST STE 111
WILMINGTON DE
19801-1156
US

IV. Provider business mailing address

1201 N MARKET ST STE 111
WILMINGTON DE
19801-1156
US

V. Phone/Fax

Practice location:
  • Phone: 302-800-0361
  • Fax: 302-800-0365
Mailing address:
  • Phone: 302-800-0361
  • Fax: 302-800-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PATIENCE B ROESLER
Title or Position: OWNER
Credential:
Phone: 302-800-0361