Provider Demographics
NPI:1467011999
Name:SKYLIGHT SUPPORT SERVICES
Entity Type:Organization
Organization Name:SKYLIGHT SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBINOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-967-3051
Mailing Address - Street 1:24 TEMPLE PL
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2911
Mailing Address - Country:US
Mailing Address - Phone:908-967-3051
Mailing Address - Fax:973-314-4064
Practice Address - Street 1:24 TEMPLE PL
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2911
Practice Address - Country:US
Practice Address - Phone:908-967-3051
Practice Address - Fax:973-314-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450347228Medicaid