NPIMap

Organization Active NPI

Peace River Center for Personal Development Inc

Doing business as Peace River Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bartow, FL
National Provider Identifier
1821097767
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC
Doing business as
Peace River Center
Practice address
1239 E Main St
Bartow, FL 33830-5058
Phone
(863) 519-0575
Fax
(863) 582-9251
NPI assigned
Jul 20, 2005
Last updated
Apr 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jo Deck, BA, CPCNPI 1992103964
Title
Credentialing Specialist
Phone
(863) 519-0575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Rural Health Clinic/Center 261QR1300X
Special Hospital 284300000X
Mental Illness Community Based Residential Treatment Facility 320800000X
Psychiatric Residential Treatment Facility 323P00000X
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

1239 E Main St
Bartow, FL 33830-5058

Mailing address

PO Box 1559
Bartow, FL 33831-1559
Phone (863) 519-0575

Other practice location 1

1835 Gilmore Ave
Lakeland, FL 33805-3017
Phone (863) 519-0575

Other practice location 2

1255 Golfview Ave
Bartow, FL 33830-6736
Phone (863) 519-0575 ext. 6494

Other practice location 3

3750 Emergency Ln Ste 1
Sebring, FL 33870-5500
Phone (863) 519-0575 ext. 6494

Other practice location 4

1664 Williamsburg Sq
Lakeland, FL 33803-4278
Phone (863) 519-0575 ext. 6494

Other practice location 5

1831 N Crystal Lake Dr
Lakeland, FL 33801-5902
Phone (863) 519-0575 ext. 6494

Other practice location 6

213 E Orange St
Wauchula, FL 33873-2934
Phone (863) 519-0575

Other practice location 7

715 N Lake Ave
Lakeland, FL 33801-1908
Phone (863) 519-0575

Other practice location 8

3241 Lakeland Hills Blvd
Lakeland, FL 33805-2266
Phone (863) 519-0575

Other practice location 9

1825 Gilmore Ave
Lakeland, FL 33805-3017
Phone (863) 519-0575

Other practice location 10

230 S Lake Parker Ave
Lakeland, FL 33801-5742
Phone (863) 582-9251 ext. 6494

Other practice location 11

2014 Lakeland Hills Blvd
Lakeland, FL 33805-2904
Phone (863) 519-0575 ext. 6494

Other practice location 12

728 E Bella Vista St
Lakeland, FL 33805-3088
Phone (863) 519-0575 ext. 6494

Other practice location 13

751 Scenic Hwy
Haines City, FL 33844-7500
Phone (863) 519-0575 ext. 6494

Other practice location 14

1831 Gilmore Ave
Lakeland, FL 33805-3017
Phone (863) 519-0575

Other identifiers 29

IdentifierTypeStateIssuer
060310400MedicaidFL
060310401MedicaidFL
060310410MedicaidFL
060310424MedicaidFL
060310405MedicaidFL
060310412MedicaidFL
060310414MedicaidFL
060310417MedicaidFL
060310411MedicaidFL
060310419MedicaidFL
060310425MedicaidFL
060310434MedicaidFL
060310435MedicaidFL
060310439MedicaidFL
060310404MedicaidFL
060310421MedicaidFL
060310422MedicaidFL
060310438MedicaidFL
060310429MedicaidFL
103255300MedicaidFL
060310406MedicaidFL
060310413MedicaidFL
060310426MedicaidFL
060310432MedicaidFL
060310415MedicaidFL
060310409MedicaidFL
060310423MedicaidFL
060310437MedicaidFL
103255700MedicaidFL

Other names 1

  • Peace River Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000056 FL Part B Supplier - Clinic/Group Practice 7719877927 Receives reassigned benefits from 56 practitioners
Practice locations: Wauchula, FL; Sebring, FL; Lakeland, FL; Lake Wales, FL; Haines City, FL; Bartow, FL; Avon Park, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2334538Peace River Center3750 Emergency Lane, Sebring, FL 33870Certificate of waiverNov 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peace River Center for14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

106 N Main Ave
Lake Placid, FL 33852
Phone (863) 452-2252

815 State Road 60 E
Lake Wales, FL 33853

1644 Williamsburg SQ
Lakeland, FL 33803

1664 Williamsburg Sq
Lakeland, FL 33803
Phone (863) 316-5498

1825 Gilmore Ave
Lakeland, FL 33805
Phone (863) 248-3300

1831 Gilmore Ave
Lakeland, FL 33805
Phone 8635190575 ext. 6494

1831 N Crystal Lake Dr
Lakeland, FL 33801
Phone 8635190575 ext. 6494

2014 Lakeland Hills Blvd
Lakeland, FL 33805
Phone 8635190575 ext. 6494

217 N Wabash Ave
Lakeland, FL 33815
Phone (863) 413-3267

600 El Paseo
Lakeland, FL 33805
Phone (863) 619-5999

728 E Bella Vista St
Lakeland, FL 33805
Phone (863) 413-2688

728 E Bella Vista St
#2
Lakeland, FL 33805

1968 Sebring Pkwy
Sebring, FL 33870
Phone (305) 244-3469

3201 Medical Way
Sebring, FL 33870

3201 Medical Way
Ste 104
Sebring, FL 33870
Phone 86351905756494

213 E Orange St
#B
Wauchula, FL 33873
Phone (863) 773-3228

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • HealthSun Health Plans Network
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Practitioners & affiliated clinicians

Practitioners 129

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 129

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776211200000",
    "number": "1821097767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338311559",
            "telephone_number": "863-519-0575",
            "fax_number": "863-582-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 E MAIN ST",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338305058",
            "telephone_number": "863-519-0575",
            "fax_number": "863-582-9251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1835 Gilmore Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338053017",
            "country_code": "US",
            "telephone_number": "863-519-0575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1255 Golfview Ave",
            "address_purpose": "LOCATION",
            "city": "Bartow",
            "state": "FL",
            "postal_code": "338306736",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3750 Emergency Ln Ste 1",
            "address_purpose": "LOCATION",
            "city": "Sebring",
            "state": "FL",
            "postal_code": "338705500",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1664 Williamsburg Sq",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338034278",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1831 N Crystal Lake Dr",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338015902",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "213 E Orange St",
            "address_purpose": "LOCATION",
            "city": "Wauchula",
            "state": "FL",
            "postal_code": "338732934",
            "country_code": "US",
            "telephone_number": "863-519-0575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "715 N Lake Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338011908",
            "country_code": "US",
            "telephone_number": "863-519-0575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3241 Lakeland Hills Blvd",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338052266",
            "country_code": "US",
            "telephone_number": "863-519-0575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1825 Gilmore Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338053017",
            "country_code": "US",
            "telephone_number": "863-519-0575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "230 S Lake Parker Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338015742",
            "country_code": "US",
            "telephone_number": "863-582-9251 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2014 Lakeland Hills Blvd",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338052904",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "728 E Bella Vista St",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338053088",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "751 Scenic Hwy",
            "address_purpose": "LOCATION",
            "city": "Haines City",
            "state": "FL",
            "postal_code": "338447500",
            "country_code": "US",
            "telephone_number": "863-519-0575 x6494",
            "fax_number": "863-582-9251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1831 Gilmore Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338053017",
            "country_code": "US",
            "telephone_number": "863-519-0575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A",
        "authorized_official_last_name": "DECK",
        "authorized_official_first_name": "JO",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "863-519-0575",
        "authorized_official_credential": "BA, CPC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310401",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310410",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310424",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310405",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310412",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310414",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310417",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310411",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310419",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310425",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310434",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310435",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310439",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310404",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310421",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310422",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310438",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310429",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103255300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310406",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310413",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310426",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310432",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310415",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310409",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310423",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060310437",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103255700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peace River Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bartow, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.