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CommonPlace Wellness, LLC.

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Company Details

Name: CommonPlace Wellness, LLC.
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 10 Jul 2024 (a year ago)
Financial Date End: 31 Jul 2026
Entity Number: 5816544
Place of Formation: IDAHO
File Number: 945441
ZIP code: 83702
County: Ada County
Principal Address: 500 WEST BANNOCK STREET BOISE, ID 83702
Mailing Address: 500 W BANNOCK ST BOISE, ID 83702-5916

Agent

Name Role Address
Issa Ntakarutimana Agent 500 WEST BANNOCK STREET, BOISE, ID 83702

Manager

Name Role Address Appointed On
Issa Ntakarutimana Manager 500 WEST BANNOCK, BOISE, ID 83702 2025-06-20

National Provider Identifier

NPI Number:
1013745546
Certification Date:
2025-05-18

Authorized Person:

Name:
ISSA NTAKARUTIMANA
Role:
OWNER / CLINICIAN
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006325369 2025-06-20
Initial Filing 0005816544 2024-07-10

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Date of last update: 21 Jun 2025

Sources: Idaho Secretary of State