Healthcare Provider Details

I. General information

NPI: 1285230482
Provider Name (Legal Business Name): PEGASUS FARM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7490 EDISON ST NE
HARTVILLE OH
44632-9328
US

IV. Provider business mailing address

7490 EDISON ST NE
HARTVILLE OH
44632-9328
US

V. Phone/Fax

Practice location:
  • Phone: 330-935-2300
  • Fax: 330-935-0620
Mailing address:
  • Phone: 330-935-2300
  • Fax: 330-935-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN LAYTON
Title or Position: ADULT SERVICES DIRECTOR
Credential:
Phone: 330-935-2300