Provider Demographics
NPI:1801239470
Name:ROYAL HOMESTAR LLC
Entity type:Organization
Organization Name:ROYAL HOMESTAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:77 S COMMERCE WAY
Mailing Address - Street 2:SUITE 230
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 1:562 W PENN PIKE
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-5654
Practice Address - Country:US
Practice Address - Phone:570-688-7814
Practice Address - Fax:570-668-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies