Provider Demographics
NPI:1477016608
Name:SKYLARK TESTING CENTER, LLC
Entity Type:Organization
Organization Name:SKYLARK TESTING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZZUTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:434-433-3003
Mailing Address - Street 1:831 W DANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-3003
Mailing Address - Country:US
Mailing Address - Phone:434-433-3003
Mailing Address - Fax:
Practice Address - Street 1:831 W DANVILLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-3003
Practice Address - Country:US
Practice Address - Phone:434-433-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic