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General NPI Number Information
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NPI Number | 1487514113
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Entity Type | Organization
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Legal Business Name | PROJECT PATCH
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 116 BRUSH CREEK RD
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City | GARDEN VALLEY
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State | ID
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Zip | 83622-1011
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Country | US
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Telephone | 208-739-8991
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Fax |
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Provider Business Mailing Address
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Address Line | 116 BRUSH CREEK RD
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City | GARDEN VALLEY
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State | ID
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Zip | 83622-1011
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Country | US
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Telephone | 208-739-8991
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Fax |
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Authorized Official
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Title or Position | INTERN
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Name | JILL WHITE
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Credential |
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Telephone | 208-739-8991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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