Organization
PROJECT PATCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL WHITE (INTERN)
(208) 739-8991
Entity
Organization
Contact information
Practice address
116 BRUSH CREEK RD, GARDEN VALLEY, ID 83622-1011
(208) 739-8991
Mailing address
116 BRUSH CREEK RD, GARDEN VALLEY, ID 83622-1011
(208) 739-8991
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/14/2025
Last updated
11/14/2025
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