Provider Demographics
NPI:1386781318
Name:FAITH 7 ACTIVITY CENTER
Entity type:Organization
Organization Name:FAITH 7 ACTIVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PYEATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-275-4223
Mailing Address - Street 1:301 S KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-7613
Mailing Address - Country:US
Mailing Address - Phone:405-275-4223
Mailing Address - Fax:405-273-2994
Practice Address - Street 1:301 S KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7613
Practice Address - Country:US
Practice Address - Phone:405-275-4223
Practice Address - Fax:405-273-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100632930AOtherDDSD WAIVER
OK100632930BOtherDDSD WAIVER
OK100632930EOtherDDSD WAIVER
OK100632930FOtherDDSD WAIVER