Provider Demographics
NPI:1366447534
Name:PEGASUS HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:PEGASUS HOME HEALTH CARE INC
Other - Org Name:PEGASUS HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPISZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-551-1932
Mailing Address - Street 1:132 N MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4235
Mailing Address - Country:US
Mailing Address - Phone:818-551-1932
Mailing Address - Fax:818-551-1936
Practice Address - Street 1:132 N MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4235
Practice Address - Country:US
Practice Address - Phone:818-551-1932
Practice Address - Fax:818-551-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000856251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57479FMedicaid
CAHHA57479FMedicaid