Organization
PEACE RIVER CENTER FOR PESONAL DEVELOPMENT, INC.
Active
Other names
Peace River Center - BCSU
Organization subpart
No
Provider details
NPI number
Authorized official
JO DECK BA (CREDENTIALING SPECIALIST)
(863) 519-0575
Entity
Organization
Contact information
Practice address
1255 GOLFVIEW AVE, BARTOW, FL 33830-6736
(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
284300000X
Special Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103255300
—
FL
Enumeration date
07/31/2024
Last updated
07/31/2024
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