Healthcare Provider Details

I. General information

NPI: 1386566131
Provider Name (Legal Business Name): FIRST STATE YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LEA BLVD
WILMINGTON DE
19802-2371
US

IV. Provider business mailing address

700 ROCKLAND RD # 131
ROCKLAND DE
19732-9900
US

V. Phone/Fax

Practice location:
  • Phone: 302-384-1144
  • Fax:
Mailing address:
  • Phone: 302-384-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: CHARINE K RUSSELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 302-384-1144