Organization
PROJECT PATCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHUCK A HAGELE (CHIEF OPERATING OFFICER)
(360) 690-8495
Entity
Organization
Contact information
Practice address
25 MIRACLE LN # 450, GARDEN VALLEY, ID 83622-1044
(208) 462-3074
(208) 462-3209
Mailing address
PO BOX 820209, VANCOUVER, WA 98682-0004
(360) 690-8495
(360) 690-8498
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
26124
ID
323P00000X
Psychiatric Residential Treatment Facility
Primary
26124
ID
Other
Enumeration date
01/08/2010
Last updated
04/28/2026
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