FIRST STATE RESIDENTIAL LIVING LLC NPI 1790344901

NPI Information

FIRST STATE RESIDENTIAL LIVING LLC is an intellectual and developmental disabilities in New Castle, DE. FIRST STATE RESIDENTIAL LIVING LLC NPI is 1790344901. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

92 READS WAY UNIT 108
NEW CASTLE, DE
ZIP 19720-631
Phone: (302) 322-2743
Fax: (302) 450-1368

The provider's authorized official is Nicholas A. Mannino .
The authorized official title is President and has the following contact phone number (302) 322-2743.

The CLIA number assigned to this NPI record is 08D0938452 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/11/2019 and was last updated on 6/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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