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 SP;ECIALIST)
(863) 519-0575
Entity
Organization
Contact information
Practice address
230 S LAKE PARKER AVE, LAKELAND, FL 33801-5742
(863) 519-0575
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
(863) 519-0575
(863) 582-9251
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060310401
—
FL
Enumeration date
02/14/2022
Last updated
05/24/2023
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