Provider Demographics
NPI:1326340050
Name:ST. LUKE'S HOMESTAR SERVICES LLC
Entity Type:Organization
Organization Name:ST. LUKE'S HOMESTAR SERVICES LLC
Other - Org Name:HOMESTAR MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOROCH
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:610-419-7610
Mailing Address - Street 1:77 S COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:610-419-7610
Mailing Address - Fax:610-882-9105
Practice Address - Street 1:1200 WELSH RD
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-3771
Practice Address - Country:US
Practice Address - Phone:215-529-6351
Practice Address - Fax:610-882-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1000002573332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021947390004Medicaid
39HA15OtherCAPITAL BLUE CROSS
213649OtherHIGHMARK
6112210001Medicare NSC