Provider Demographics
NPI:1780010389
Name:ROYAL HOMESTAR, LLC
Entity Type:Organization
Organization Name:ROYAL HOMESTAR, LLC
Other - Org Name:HOMESTAR MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOUGLAS WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-420-5657
Mailing Address - Street 1:122 MILL RD
Mailing Address - Street 2:SUITE A130
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1701
Practice Address - Country:US
Practice Address - Phone:610-379-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies