MEDICARE: PEGASUS BEHAVIORAL HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1932638541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEGASUS BEHAVIORAL HEALTH INC

Provider Business Mailing Address
First Line	:	9935 PALOMINO DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-1014
Country	:	US
Telephone Number	:	954-696-1121
Fax Number	:	954-357-3624

Provider Business Practice Location Address
First Line	:	9935 PALOMINO DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-1014
Country	:	US
Telephone Number	:	561-370-3867
Fax Number	:	561-828-5902

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	JULIE CROCCO
Credential	:
Telephone Number	:	954-696-1121

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	07/21/2022

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