Healthcare Provider Details

I. General information

NPI: 1316801509
Provider Name (Legal Business Name): ELVA CHINABALIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALVA CHINABALIRE

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 W GROVER ST APT 14
BOISE ID
83705-6405
US

IV. Provider business mailing address

4830 N CRESTHAVEN CIR
BOISE ID
83704-3009
US

V. Phone/Fax

Practice location:
  • Phone: 208-353-7695
  • Fax:
Mailing address:
  • Phone: 208-353-7695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: