Healthcare Provider Details

I. General information

NPI: 1467375576
Provider Name (Legal Business Name): JADE HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD STE 404
BOISE ID
83706-1342
US

IV. Provider business mailing address

901 N CURTIS RD STE 404
BOISE ID
83706-1342
US

V. Phone/Fax

Practice location:
  • Phone: 240-359-4300
  • Fax: 240-359-4300
Mailing address:
  • Phone: 240-359-4300
  • Fax: 240-359-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLENA IVASHCHUK
Title or Position: BOARD MEMBER
Credential:
Phone: 240-359-4300