MEDICARE: ST. LUKE'S HOMESTAR SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1000002573	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	39HA15	OTHER	CAPITAL BLUE CROSS
3	213649	OTHER	HIGHMARK

General Provider Information

NPI Number	:	1326340050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUKE'S HOMESTAR SERVICES LLC

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

Provider Business Practice Location Address
First Line	:	1200 WELSH RD
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3771
Country	:	US
Telephone Number	:	215-529-6351
Fax Number	:	610-882-9105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEITH BOROCH
Credential	:	COO
Telephone Number	:	610-419-7610

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/10/2010

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