Provider Demographics
NPI:1205601564
Name:PATCHWORK HOPE LLC
Entity type:Organization
Organization Name:PATCHWORK HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MANTHEI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:928-587-5462
Mailing Address - Street 1:409 N COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-4017
Mailing Address - Country:US
Mailing Address - Phone:928-587-5462
Mailing Address - Fax:
Practice Address - Street 1:409 N COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-4017
Practice Address - Country:US
Practice Address - Phone:928-587-5462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty