MEDICARE: PEGASUS FREEDOM REINS OHIO

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1043806748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEGASUS FREEDOM REINS OHIO

Provider Business Mailing Address
First Line	:	PO BOX 174
Second Line	:
City	:	UNIONVILLE CENTER
State	:	OH
Zip	:	43077-0174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16090 HAWN RD
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-9730
Country	:	US
Telephone Number	:	937-707-0050
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JO REILLY-PANICCIA
Credential	:
Telephone Number	:	937-707-0050

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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Directions to “PEGASUS FREEDOM REINS OHIO ” Practice Location

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