| Commonplace Wellness Llc | |
|
500 W Bannock St Boise ID 83702-5916 | |
| (208) 906-5878 | |
| Not Available |
| Full Name | Commonplace Wellness Llc |
|---|---|
| Speciality | Counselor |
| Location | 500 W Bannock St, Boise, Idaho |
| Authorized Official Name and Position | Issa Ntakarutimana (OWNER / CLINICIAN) |
| Authorized Official Contact | 2089065878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Commonplace Wellness Llc 205 S Bruce Ln Boise ID 83712-7804 Ph: () - | Commonplace Wellness Llc 500 W Bannock St Boise ID 83702-5916 Ph: (208) 906-5878 |
| NPI Number | 1013745546 |
|---|---|
| Provider Enumeration Date | 07/25/2024 |
| Last Update Date | 05/18/2025 |
| Certification Date | 05/18/2025 |
| Medicare PECOS PAC ID | 7113454943 |
|---|---|
| Medicare Enrollment ID | O20241218001372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013745546 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Issa Ntakarutimana |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821681982 PECOS PAC ID: 8022545854 Enrollment ID: I20241218002613 |
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