Organization
PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JO DECK (CREDENTIALING SPECIALIST)
(863) 519-0575
Entity
Organization
Contact information
Practice address
1831 GILMORE AVE, LAKELAND, FL 33805-3017
(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
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060310424
—
FL
Enumeration date
10/19/2023
Last updated
10/19/2023
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