Provider Demographics
NPI:1003086455
Name:ST LUKES HOMESTAR SERVICES LLC
Entity Type:Organization
Organization Name:ST LUKES HOMESTAR SERVICES LLC
Other - Org Name:HOMESTAR RX AND INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGIONI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:484-526-7650
Mailing Address - Street 1:77 S COMMERCE WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8917
Mailing Address - Country:US
Mailing Address - Phone:610-954-4210
Mailing Address - Fax:610-882-0246
Practice Address - Street 1:77 S COMMERCE WAY
Practice Address - Street 2:STE 200
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8917
Practice Address - Country:US
Practice Address - Phone:610-954-4210
Practice Address - Fax:610-882-0246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-01
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP-481788251F00000X, 3336H0001X
PAFH0725412261QM2500X
PA1000002573332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021941790003Medicaid
PA213649OtherHIGHMARK
PA6112210002OtherMEDICARE NHIC PTAN
PA39HA15OtherCAPITAL BLUE CROSS
PA121601OtherTHREE RIVERS