Healthcare Provider Details

I. General information

NPI: 1477898575
Provider Name (Legal Business Name): PACT OF FAITH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 DAHLIA DR
ORLANDO FL
32807-3238
US

IV. Provider business mailing address

5817 DAHLIA DR
ORLANDO FL
32807-3238
US

V. Phone/Fax

Practice location:
  • Phone: 407-300-5813
  • Fax: 407-249-2528
Mailing address:
  • Phone: 407-300-5813
  • Fax: 407-249-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number26471961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateFL

VIII. Authorized Official

Name: DEANNYS C VARGAS
Title or Position: CEO
Credential: EXECUTIVE DIRECTOR
Phone: 407-300-5813