| Peace River Center For Personal Development Inc | |
|
1831 Gilmore Ave Lakeland FL 33805-3017 | |
| (863) 519-0575 | |
| (863) 582-9251 |
| Full Name | Peace River Center For Personal Development Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1831 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 1831 Gilmore Ave Lakeland FL 33805-3017 Ph: (863) 519-0575 |
| NPI Number | 1174305635 |
|---|---|
| Provider Enumeration Date | 10/19/2023 |
| Last Update Date | 10/19/2023 |
| Certification Date | 10/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174305635 | NPI | - | NPPES |
| 060310424 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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