Organization · NPI-2

4maple Haven

Community/Behavioral Health · Boise, ID

NPI number1497627640
StatusActive
Last updated in NPPESNov 4, 2025

Details

NPI
1497627640
Entity type
Organization (NPI-2)
Legal business name
4maple Haven
Organization subpart
No
Enumeration date
Sep 18, 2025
Certification date
Nov 4, 2025
Last updated
Nov 4, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral Health––Yes

Practice location

9492 W Fairview Ave
Boise, ID 83704-8101

Phone 208-936-0670

Mailing address

9492 W Fairview Ave
Boise, ID 83704-8101

Phone 208-936-0670

Authorized official

Ferdinand Nyabenda
Owner
2089360670

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