Provider Demographics
NPI:1043394612
Name:HOME INFUSION OF LUZERNE COUNTY
Entity Type:Organization
Organization Name:HOME INFUSION OF LUZERNE COUNTY
Other - Org Name:THERAPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:513-891-6666
Mailing Address - Street 1:1000 MEADE STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512
Mailing Address - Country:US
Mailing Address - Phone:570-961-5100
Mailing Address - Fax:570-961-8599
Practice Address - Street 1:390 PIERCE STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-288-9388
Practice Address - Fax:570-763-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481303251F00000X, 261QI0500X, 332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336H0001X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001472006003Medicaid
PA001472006003Medicaid