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General NPI Number Information
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NPI Number | 1326340050
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S HOMESTAR SERVICES LLC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 1200 WELSH RD
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City | NORTH WALES
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State | PA
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Zip | 19454-3771
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Country | US
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Telephone | 215-529-6351
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Fax | 610-882-9105
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Provider Business Mailing Address
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Address Line | 77 S COMMERCE WAY
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City | BETHLEHEM
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State | PA
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Zip | 18017
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Country | US
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Telephone | 610-419-7610
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Fax | 610-882-9105
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEITH BOROCH
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Credential | COO
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Telephone | 610-419-7610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1000002573
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License Number State | PA
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