Healthcare Provider Details

I. General information

NPI: 1396660452
Provider Name (Legal Business Name): INNOCENT NKURUNZIZA SENGABIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7349 S MENZINGERS AVE
MERIDIAN ID
83642-1524
US

IV. Provider business mailing address

7349 S MENZINGERS AVE
MERIDIAN ID
83642-1524
US

V. Phone/Fax

Practice location:
  • Phone: 208-296-4470
  • Fax:
Mailing address:
  • Phone: 208-296-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: