Healthcare Provider Details

I. General information

NPI: 1407229677
Provider Name (Legal Business Name): FIRST STATE REHAB AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OXFORD PL
WILMINGTON DE
19803-4517
US

IV. Provider business mailing address

111 OXFORD PL
WILMINGTON DE
19803-4517
US

V. Phone/Fax

Practice location:
  • Phone: 443-252-7367
  • Fax: 888-509-1710
Mailing address:
  • Phone: 302-304-9729
  • Fax: 888-509-1710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JOSEPH GANGEMI
Title or Position: PRESIDENT
Credential: P.T., D.P.T.
Phone: 302-304-9729