Provider Demographics
NPI:1629238142
Name:ST. LUKE'S HOMESTAR SERVICES, LLC
Entity type:Organization
Organization Name:ST. LUKE'S HOMESTAR SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:77 S COMMERCE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8917
Mailing Address - Country:US
Mailing Address - Phone:484-526-7600
Mailing Address - Fax:
Practice Address - Street 1:77 S COMMERCE WAY
Practice Address - Street 2:SUITE 230
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8917
Practice Address - Country:US
Practice Address - Phone:484-526-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKE'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-10
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1000002573332BP3500X, 332BX2000X, 332B00000X
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
PA6112210001Medicare NSC