# PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peace River Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265187728
- **Authorized official:** JO DECK BA, CPC (CREDENTIALING SP;ECIALIST)
- **Authorized official phone:** (863) 519-0575

## Contact information

- **Practice address:** 230 S LAKE PARKER AVE, LAKELAND, FL 33801-5742
- **Practice address phone:** (863) 519-0575
- **Mailing address:** PO BOX 1559, BARTOW, FL 33831-1559
- **Mailing address phone:** (863) 519-0575
- **Mailing address fax:** (863) 582-9251

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 02/14/2022
- **Last updated:** 05/24/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 060310401 | — | FL |