Healthcare Provider Details

I. General information

NPI: 1003086455
Provider Name (Legal Business Name): ST LUKES HOMESTAR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2008
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S COMMERCE WAY STE 200
BETHLEHEM PA
18017-8917
US

IV. Provider business mailing address

77 S COMMERCE WAY STE 200
BETHLEHEM PA
18017-8917
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-4210
  • Fax: 610-882-0246
Mailing address:
  • Phone: 610-954-4210
  • Fax: 610-882-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberPP-481788
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberFH0725412
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1000002573
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPP-481788
License Number StatePA

VIII. Authorized Official

Name: MR. JOSEPH BORGIONI
Title or Position: PHARMACY ADMINISTRATOR
Credential: RPH
Phone: 484-526-7650