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
1239 E MAIN ST, BARTOW, FL 33830-5058
(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
207Q00000X
Family Medicine Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
284300000X
Special Hospital
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060310400
—
FL
05
—
060310401
—
FL
05
—
060310404
—
FL
05
—
060310405
—
FL
05
—
060310406
—
FL
05
—
060310409
—
FL
05
—
060310410
—
FL
05
—
060310411
—
FL
05
—
060310412
—
FL
05
—
060310413
—
FL
05
—
060310414
—
FL
05
—
060310415
—
FL
05
—
060310417
—
FL
05
—
060310419
—
FL
05
—
060310421
—
FL
05
—
060310422
—
FL
05
—
060310423
—
FL
05
—
060310424
—
FL
05
—
060310425
—
FL
05
—
060310426
—
FL
05
—
060310429
—
FL
05
—
060310432
—
FL
05
—
060310434
—
FL
05
—
060310435
—
FL
05
—
060310437
—
FL
05
—
060310438
—
FL
05
—
060310439
—
FL
05
—
103255300
—
FL
05
—
103255700
—
FL
Enumeration date
07/20/2005
Last updated
04/15/2026
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