Provider Demographics
NPI:1508025586
Name:HOMESTAR MED EQUIP & INF SVS
Entity Type:Organization
Organization Name:HOMESTAR MED EQUIP & INF SVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DESARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
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:18017-8917
Mailing Address - Country:US
Mailing Address - Phone:610-419-7600
Mailing Address - Fax:610-882-9105
Practice Address - Street 1:1200 WELSH RD
Practice Address - Street 2:STORE M
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-3771
Practice Address - Country:US
Practice Address - Phone:215-361-9794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1000002573332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1241270002Medicare NSC