Provider Demographics
NPI:1285230482
Name:PEGASUS FARM
Entity Type:Organization
Organization Name:PEGASUS FARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-935-2300
Mailing Address - Street 1:7490 EDISON ST NE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9328
Mailing Address - Country:US
Mailing Address - Phone:330-935-2300
Mailing Address - Fax:330-935-0620
Practice Address - Street 1:7490 EDISON ST NE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9328
Practice Address - Country:US
Practice Address - Phone:330-935-2300
Practice Address - Fax:330-935-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3118263Medicaid