Provider Demographics
NPI:1356089973
Name:MCNICHOLAS, LLC
Entity Type:Organization
Organization Name:MCNICHOLAS, LLC
Other - Org Name:VITAL CARE OF BOISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCNICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-670-1625
Mailing Address - Street 1:12828 W LASALLE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1517
Mailing Address - Country:US
Mailing Address - Phone:623-670-1625
Mailing Address - Fax:
Practice Address - Street 1:12828 W LASALLE ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1517
Practice Address - Country:US
Practice Address - Phone:623-670-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy