Provider Demographics
NPI:1376114769
Name:SKYLIGHT HEALTH GROUP CO LLC
Entity Type:Organization
Organization Name:SKYLIGHT HEALTH GROUP CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCHACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-689-9706
Mailing Address - Street 1:82 HARTWELL ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3025
Mailing Address - Country:US
Mailing Address - Phone:150-868-9970
Mailing Address - Fax:
Practice Address - Street 1:3100 N ACADEMY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5332
Practice Address - Country:US
Practice Address - Phone:719-301-7162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center