Healthcare Provider Details

I. General information

NPI: 1356721658
Provider Name (Legal Business Name): 1ST STATE ACCESSIBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BROOKSIDE DR
WILMINGTON DE
19804-1103
US

IV. Provider business mailing address

105 BROOKSIDE DR
WILMINGTON DE
19804-1103
US

V. Phone/Fax

Practice location:
  • Phone: 302-559-5652
  • Fax: 844-663-4396
Mailing address:
  • Phone: 302-559-5652
  • Fax: 844-663-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2015603828
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: TEAL A CONNELL
Title or Position: OWNER
Credential:
Phone: 302-559-5652