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PURE Healthcare of Idaho LLC

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Company Details

Name: PURE Healthcare of Idaho LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 08 Oct 2019 (6 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 3644465
Place of Formation: IDAHO
File Number: 683409
ZIP code: 83704
County: Ada County
Principal Address: 6550 W EMERALD ST BOISE, ID 83704
Mailing Address: 4179 S RIVERBOAT ROAD SUITE 220 TAYLORSVILLE, UT 84123

Manager

Name Role Address Appointed On
Kevin McKenzie Manager 4179 RIVERBOAT ROAD, TAYLORSVILLE, UT 84123 2023-02-23
Daniel Smith Manager 4179 RIVERBOAT ROAD, TAYLORSVILLE, UT 84123 2023-09-22
Pure Infusion Suites, LLC Manager 784 S. CLEARWATER LOOP STE B, POST FALLS, ID 83854 2024-09-02

Agent

Name Role Address
NORTHWEST REGISTERED AGENT LLC Agent 784 S CLEARWATER LOOP STE B, POST FALLS, ID 83854

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
MP64H7752HU5
UEI Expiration Date:
2026-01-07

Business Information

Activation Date:
2025-01-09
Initial Registration Date:
2024-02-08

National Provider Identifier

NPI Number:
1568005809
Certification Date:
2025-05-06

Authorized Person:

Name:
RACHEL FRAGA
Role:
CONTRACTING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
8013270211

Filing

Filing Name Filing Number Filing date
Annual Report 0005875512 2024-09-02
Annual Report 0005408839 2023-09-22
Application for Reinstatement 0005117270 2023-02-23
Dissolution/Revocation - Administrative 0004130830 2021-01-12
Initial Filing 0003644465 2019-10-08

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Date of last update: 17 May 2025

Sources: Idaho Secretary of State