Healthcare Provider Details

I. General information

NPI: 1669636155
Provider Name (Legal Business Name): ST. LUKES HOMESTAR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WELSH RD STORE M
NORTH WALES PA
19454-3771
US

IV. Provider business mailing address

77 S COMMERCE WAY
BETHLEHEM PA
18017-8917
US

V. Phone/Fax

Practice location:
  • Phone: 215-361-9794
  • Fax:
Mailing address:
  • Phone: 610-419-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DOMINICK DESARRO
Title or Position: ADMINISTRATOR
Credential:
Phone: 610-419-7600