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PEACE RIVER CENTER
NPI 1104572551
Psychiatry & Neurology - Psychiatry in Bartow, FL

Active since February 24, 2022CLIA Certified · 9 labs
1255 GOLFVIEW AVE, BARTOW, FL 33830(863) 519-0575(863) 582-9251 Get Directions Write a Review

NPPES record last updated: February 1, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 1, 2023, Feb 24, 2022 (2 updates tracked since 2022).

About Peace River Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEACE RIVER CENTER (NPI 1104572551) is a healthcare organization registered as a psychiatry in Bartow, Florida and active in the NPI registry since February 2022. The organization holds 9 active CLIA laboratory certificates and lists Jo Deck, Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1104572551
Entity TypeOrganization
Primary Taxonomy2084P0800X
Legal Business NamePEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC
Location Address1255 GOLFVIEW AVEBartow, FL 33830-6736
Mailing AddressPo Box 1559Bartow, FL 33831-1559 · (863) 519-0575 · Fax (863) 582-9251
Phone(863) 519-0575
Fax(863) 582-9251
Organization SubpartNo
Authorized OfficialJo DeckCredentialing Specialist · (863) 519-0575
Enumeration DateFebruary 24, 2022
Last NPPES UpdateFebruary 1, 20232 updates tracked since enumeration
NPPES CertifiedFebruary 1, 2023
✔ NPI 1104572551 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0800X
Definition
A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
1255 GOLFVIEW AVE, Bartow, FL 33830
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Other Names 1

Doing Business AsPeace River Center

Other Identifiers 1

Medicaid060310438FL

CLIA Laboratory Certificates CMS CLIA 10

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0292918

Peace River Center Crisis Stablilization Unit · Bartow, FL
Active · expires Jun 20, 2027
CLIA Number10D0292918
Laboratory TypeMental Health Facility
Certificate Effective DateJune 21, 2025
Certificate Expiration DateJune 20, 2027
Laboratory DirectorJames King
Laboratory Phone(863) 519-0575
Laboratory LocationPeace River Center Crisis Stablilization Unit1255 Golfview Ave, Bartow, FL 33830
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2334538

Peace River Center · Sebring, FL
Active · expires Nov 23, 2027
CLIA Number10D2334538
Laboratory TypeBehavioral Health Care
Certificate Effective DateNovember 24, 2025
Certificate Expiration DateNovember 23, 2027
Laboratory DirectorMignon P. Burr
Laboratory Phone(863) 519-0575
Laboratory LocationPeace River Center3750 Emergency Lane, Sebring, FL 33870
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2104234

Peace River Center Wellness Clinic · Lakeland, FL
Active · expires Oct 29, 2027
CLIA Number10D2104234
Laboratory TypeCommunity Clinic
Certificate Effective DateOctober 30, 2025
Certificate Expiration DateOctober 29, 2027
Laboratory DirectorMignon Burr
Laboratory Phone(863) 519-0575
Laboratory LocationPeace River Center Wellness Clinic1831 N Gilmore Ave, Lakeland, FL 33805
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2132695

Peace River Center - Residential Grp Homes · Lakeland, FL
Active · expires Jun 26, 2027
CLIA Number10D2132695
Laboratory TypeMental Health Residential
Certificate Effective DateJune 27, 2025
Certificate Expiration DateJune 26, 2027
Laboratory DirectorMignon P. Burr
Laboratory Phone(863) 519-0575
Laboratory LocationPeace River Center - Residential Grp Homes728 East Bella Vista Street, Lakeland, FL 33805
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2128550

Peace River Center For Personal Development, Inc · Bartow, FL
Active · expires Apr 2, 2027
CLIA Number10D2128550
Laboratory TypeSubstance Abuse Program
Certificate Effective DateApril 3, 2025
Certificate Expiration DateApril 2, 2027
Laboratory DirectorDonna R. Rininger
Laboratory Phone(863) 519-0575
Laboratory LocationPeace River Center For Personal Development, Inc1239 E Main St, Bartow, FL 33831
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2320088

Peace River Center · Lakeland, FL
Active · expires Mar 11, 2027
CLIA Number10D2320088
Laboratory TypeBehavioral Healthcare
Certificate Effective DateMarch 12, 2025
Certificate Expiration DateMarch 11, 2027
Laboratory DirectorVeronica L. Santana
Laboratory Phone(863) 519-0575
Laboratory LocationPeace River Center1225 N Gilmore Ave, Lakeland, FL 33805
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

IMPRICE JOHNSON RN
Registered Nurse
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575
SHERRY L ROSS WILLIAMS
Community Health Worker
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575
JESSICA LITTLE LMHC
Counselor (Mental Health)
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575
WILLIAM SADOWSKY MD
Psychiatry & Neurology (Psychiatry)
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575
ROBERT RIVERA
Community Health Worker
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575
AMANDA DAE BARRY RN
Registered Nurse
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575
TRAVIS RISNER
Counselor
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575
CHAD FEACHER
Counselor (Mental Health)
1255 GOLFVIEW AVE
BARTOW, FL 33830
Polk County (863) 519-0575

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Peace River Center For Personal Development Inc's NPI number?

The NPI number for Peace River Center For Personal Development Inc is 1104572551. It was assigned to this organization in the NPPES registry on February 24, 2022. The provider is doing business as Peace River Center.

Where is Peace River Center For Personal Development Inc located?

Peace River Center For Personal Development Inc is located at 1255 Golfview Ave, Bartow, FL 33830. The listed phone number is (863) 519-0575.

What is Peace River Center For Personal Development Inc's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Does Peace River Center For Personal Development Inc hold CLIA laboratory certificates?

Yes. 9 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Peace River Center For Personal Development Inc was last updated on February 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.