Provider Demographics
NPI:1558840900
Name:PURE VITA CO.
Entity Type:Organization
Organization Name:PURE VITA CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-639-9488
Mailing Address - Street 1:4775 N SUNDERLAND LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-2216
Mailing Address - Country:US
Mailing Address - Phone:725-221-3821
Mailing Address - Fax:208-639-9488
Practice Address - Street 1:4775 N SUNDERLAND LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-2216
Practice Address - Country:US
Practice Address - Phone:725-221-3821
Practice Address - Fax:208-639-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies