Provider Demographics
NPI:1619417912
Name:LICE CLINICS OF BOISE
Entity type:Organization
Organization Name:LICE CLINICS OF BOISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALEAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SNELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-999-0289
Mailing Address - Street 1:2650 S EAGLE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 S EAGLE RD STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6704
Practice Address - Country:US
Practice Address - Phone:208-999-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty