| Peace River Center For Personal Development Inc | |
|
1825 Gilmore Ave Lakeland FL 33805-3017 | |
| (863) 519-0575 | |
| (863) 582-9251 |
| Full Name | Peace River Center For Personal Development Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1825 Gilmore Ave, Lakeland, Florida |
| Authorized Official Name and Position | Jo Deck (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 8635190575 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peace River Center For Personal Development Inc Po Box 1559 Bartow FL 33831-1559 Ph: (863) 519-0575 | Peace River Center For Personal Development Inc 1825 Gilmore Ave Lakeland FL 33805-3017 Ph: (863) 519-0575 |
| NPI Number | 1538802939 |
|---|---|
| Provider Enumeration Date | 04/14/2022 |
| Last Update Date | 02/01/2023 |
| Certification Date | 02/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538802939 | NPI | - | NPPES |
| 060310439 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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