Provider Demographics
NPI:1518269109
Name:ST. LUKE'S HOMESTAR SERVICES LLC
Entity Type:Organization
Organization Name:ST. LUKE'S HOMESTAR SERVICES LLC
Other - Org Name:HOMESTAR BONE & JOINT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SYLVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-7610
Mailing Address - Street 1:1534 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1084
Mailing Address - Country:US
Mailing Address - Phone:267-424-8771
Mailing Address - Fax:215-536-4812
Practice Address - Street 1:77 S COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8917
Practice Address - Country:US
Practice Address - Phone:610-419-7600
Practice Address - Fax:885-662-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2011-08-10
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
PA39HA15OtherCAPITAL BLUE CROSS
PA1021947390004Medicaid
PA213649OtherHIGHMARK
PA39HA15OtherCAPITAL BLUE CROSS