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SAND CREEK MENTAL HEALTH & WELLNESS, LLC

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Company Details

Name: SAND CREEK MENTAL HEALTH & WELLNESS, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 04 Oct 2004 (21 years ago)
Financial Date End: 31 Oct 2007
Date dissolved: 04 Jan 2008
Entity Number: 113744
Place of Formation: IDAHO
File Number: 0000113744
ZIP code: 83835
County: Kootenai County
Principal Address: 9511 BAACK ST HAYDEN, ID 83835

National Provider Identifier

NPI Number:
1275675886

Authorized Person:

Name:
MRS. SUSAN STEVENS
Role:
PARTNER
Phone:

Taxonomy:

Selected Taxonomy:
104100000X - Social Worker
Is Primary:
No
Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
106H00000X - Marriage & Family Therapist
Is Primary:
No

Contacts:

Fax:
2082552017

Filing

Filing Name Filing Number Filing date
Legacy Amendment 0001352251 2007-08-17
Legacy Amendment 0000717689 2007-07-20
Annual Report 0001352249 2006-10-25
Legacy Amendment 0000717688 2006-07-10
Annual Report 0001352250 2005-11-08

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State