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General NPI Number Information
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NPI Number | 1912873209
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Entity Type | Organization
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Legal Business Name | 4MAPLE HAVEN
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 9492 W FAIRVIEW AVE
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City | BOISE
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State | ID
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Zip | 83704-8101
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Country | US
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Telephone | 208-936-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 9492 W FAIRVIEW AVE
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City | BOISE
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State | ID
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Zip | 83704-8101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FERDINAND NYABENDA
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Credential |
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Telephone | 208-936-0670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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