Provider Demographics
NPI:1255931937
Name:SKYLIGHT HEALTH GROUP MA PC
Entity type:Organization
Organization Name:SKYLIGHT HEALTH GROUP MA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICAL OPERATIONS
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
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:508-689-9706
Mailing Address - Fax:
Practice Address - Street 1:938 MA-6A
Practice Address - Street 2:
Practice Address - City:YARMOUTHPORT
Practice Address - State:MA
Practice Address - Zip Code:02675
Practice Address - Country:US
Practice Address - Phone:844-644-8880
Practice Address - Fax:781-859-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty