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PREMIER LIFE WELLNESS, LLC

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Company Details

Name: PREMIER LIFE WELLNESS, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 02 Aug 2007 (18 years ago)
Financial Date End: 31 Aug 2024
Date dissolved: 15 Nov 2024
Entity Number: 206894
Place of Formation: IDAHO
File Number: 206894
ZIP code: 83301
County: Twin Falls County
Principal Address: 480 BLUE LAKES BLVD TWIN FALLS, ID 83301
Mailing Address: REX M WALL 480 BLUE LAKES BLVD TWIN FALLS, ID 83301-7241

Agent

Name Role Address
DR LORI GUMPER Agent 480 BLUE LAKES BLVD, TWIN FALLS, ID 83301

Member

Name Role Address Appointed On
REX M Wall Member 480 BLUE LAKES BLVD, TWIN FALLS, ID 83301 2020-09-02

National Provider Identifier

NPI Number:
1952571234

Authorized Person:

Name:
LORAINE M GUMPER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
Yes

Contacts:

Fax:
2087359030

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005981718 2024-11-15
Annual Report 0005310269 2023-07-07
Annual Report 0004819450 2022-07-11
Annual Report 0004343645 2021-07-10
Annual Report 0003991395 2020-09-02

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Date of last update: 29 May 2025

Sources: Idaho Secretary of State