# PROJECT PATCH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457681736
- **Authorized official:** CHUCK A HAGELE (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (360) 690-8495

## Contact information

- **Practice address:** 25 MIRACLE LN \# 450, GARDEN VALLEY, ID 83622-1044
- **Practice address phone:** (208) 462-3074
- **Practice address fax:** (208) 462-3209
- **Mailing address:** PO BOX 820209, VANCOUVER, WA 98682-0004
- **Mailing address phone:** (360) 690-8495
- **Mailing address fax:** (360) 690-8498

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 26124 | ID | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | 26124 | ID | Yes |

## Other

- **Enumeration date:** 01/08/2010
- **Last updated:** 04/28/2026