1326340050 NPI number — ST. LUKE'S HOMESTAR SERVICES LLC

Table of content: (NPI 1326340050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326340050 NPI number — ST. LUKE'S HOMESTAR SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LUKE'S HOMESTAR SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOMESTAR MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326340050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 S COMMERCE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-419-7610
Provider Business Mailing Address Fax Number:
610-882-9105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WELSH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH WALES
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19454-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-529-6351
Provider Business Practice Location Address Fax Number:
610-882-9105
Provider Enumeration Date:
12/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BOROCH
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-419-7610

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1000002573 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1021947390004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39HA15 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213649 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".




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