Healthcare Provider Details

I. General information

NPI: 1578442323
Provider Name (Legal Business Name): TRI-STATE RENOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 SILVERSIDE RD
WILMINGTON DE
19810-4502
US

IV. Provider business mailing address

2228 SILVERSIDE RD
WILMINGTON DE
19810-4502
US

V. Phone/Fax

Practice location:
  • Phone: 302-332-6806
  • Fax:
Mailing address:
  • Phone: 302-332-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. SHANE M CONNELL
Title or Position: OQNWE
Credential:
Phone: 302-332-6806