Healthcare Provider Details

I. General information

NPI: 1689906836
Provider Name (Legal Business Name): FIRST STATE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 W WOODMILL DR SUITE 33 LOWER LEVEL
WILMINGTON DE
19808-4068
US

IV. Provider business mailing address

5205 W WOODMILL DR SUITE 33 LOWER LEVEL
WILMINGTON DE
19808-4068
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-4249
  • Fax: 888-459-2609
Mailing address:
  • Phone: 302-655-4249
  • Fax: 888-459-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TINA POTTS
Title or Position: CEO
Credential:
Phone: 302-655-4249