Organization
PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC
Active
Other names
Peace River Center
Organization subpart
No
Provider details
NPI number
Authorized official
JO DECK BA, CPC (CREDENTIALING SPECIALIST)
(863) 519-0575
Entity
Organization
Contact information
Practice address
230 S LAKE PARKER AVE, LAKELAND, FL 33801-5742
(863) 519-0575
(863) 582-9251
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
(863) 519-0575
(863) 582-9251
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060310423
—
FL
Enumeration date
02/24/2022
Last updated
05/24/2023
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