MEDICARE: ROYAL HOMESTAR, 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

General Provider Information

NPI Number	:	1780010389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL HOMESTAR, LLC

Provider Business Mailing Address
First Line	:	122 MILL RD
Second Line	:	SUITE A130
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-1409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S 10TH ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1701
Country	:	US
Telephone Number	:	610-379-0300
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY TREASURER/CFO
Name	:	MICHELE J DOUGLAS WILSON
Credential	:
Telephone Number	:	610-420-5657

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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