Provider Demographics
NPI:1366007395
Name:PEGUES, CHRISTINA J (LCDCIII)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:PEGUES
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 BAIRD ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1755
Mailing Address - Country:US
Mailing Address - Phone:330-813-7781
Mailing Address - Fax:
Practice Address - Street 1:24 N HIGH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1926
Practice Address - Country:US
Practice Address - Phone:732-884-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 253Z00000X, 376J00000X, 171M00000X
OH162555101YA0400X
OHSS920002342000000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No253Z00000XAgenciesIn Home Supportive Care
No342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2462Medicaid