PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC NPI 1821097767

NPI Information

NPI: 1821097767
Provider Name: PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC

Doing Business As: PEACE RIVER CENTER

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1239 E MAIN ST
BARTOW, FL
ZIP 33830
Phone: (863) 519-0575
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PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC is a mental health (including community mental health center) clinic center in Bartow, FL. PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC NPI is 1821097767. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Peace River Center.

The provider's business location address is:

1239 E MAIN ST
BARTOW, FL
ZIP 33830
Phone: (863) 519-0575
Fax: (863) 582-9251

The provider's authorized official is Jo Deck .
The authorized official title is Credentialing Specialist and has the following contact phone number (863) 519-0575.

The CLIA number assigned to this NPI record is 10D2132695 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/20/2005 and was last updated on 2/28/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		No
2	251B00000X	Case Management		No
3	261QM0850X	Clinic/Center	Adult Mental Health	No
4	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
5	261QR1300X	Clinic/Center	Rural Health	No
6	320800000X	Community Based Residential Treatment Facility, Mental Illness		No
7	284300000X	Special Hospital		No
8	323P00000X	Psychiatric Residential Treatment Facility		No
9	343900000X	Non-emergency Medical Transport (VAN)		No
10	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	060310411	MEDICAID	FLORIDA
2	060310416	MEDICAID	FLORIDA
3	060310405	MEDICAID	FLORIDA
4	060310413	MEDICAID	FLORIDA
5	060310422	MEDICAID	FLORIDA
6	060310437	MEDICAID	FLORIDA
7	060310400	MEDICAID	FLORIDA
8	060310401	MEDICAID	FLORIDA
9	060310410	MEDICAID	FLORIDA
10	761545101	MEDICAID	FLORIDA
11	060310421	MEDICAID	FLORIDA
12	060310418	MEDICAID	FLORIDA
13	060310425	MEDICAID	FLORIDA
14	060310404	MEDICAID	FLORIDA
15	060310414	MEDICAID	FLORIDA
16	060310415	MEDICAID	FLORIDA
17	060310417	MEDICAID	FLORIDA
18	060310423	MEDICAID	FLORIDA
19	060310428	MEDICAID	FLORIDA
20	060310434	MEDICAID	FLORIDA
21	060310406	MEDICAID	FLORIDA
22	060310432	MEDICAID	FLORIDA
23	060310409	MEDICAID	FLORIDA
24	060310412	MEDICAID	FLORIDA
25	060310420	MEDICAID	FLORIDA
26	060310426	MEDICAID	FLORIDA
27	060310429	MEDICAID	FLORIDA
28	060310419	MEDICAID	FLORIDA
29	060310424	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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