Provider Demographics
NPI:1477898575
Name:PACT OF FAITH, INC
Entity Type:Organization
Organization Name:PACT OF FAITH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNYS
Authorized Official - Middle Name:C
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:407-300-5813
Mailing Address - Street 1:5817 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3238
Mailing Address - Country:US
Mailing Address - Phone:407-300-5813
Mailing Address - Fax:407-249-2528
Practice Address - Street 1:5817 DAHLIA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3238
Practice Address - Country:US
Practice Address - Phone:407-300-5813
Practice Address - Fax:407-249-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26471961302F00000X
FL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid