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GRAND TETON CHILD NEUROLOGY, PLLC

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Company Details

Name: GRAND TETON CHILD NEUROLOGY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 05 Mar 2008 (17 years ago)
Financial Date End: 31 Mar 2022
Date dissolved: 24 Jun 2022
Entity Number: 226519
Place of Formation: IDAHO
File Number: 226519
ZIP code: 83401
County: Bonneville County
Principal Address: 756 OXFORD DRIVE IDAHO FALLS, ID 83401
Mailing Address: PETER CASTELLANOS STE B 2225 TETON PLZ IDAHO FALLS, ID 83404-6494

Agent

Name Role Address
MARC J WEINPEL Agent 2225 TETON PLAZA, B, IDAHO FALLS, ID 83404

Manager

Name Role Address Appointed On
Grand Teton Child Neurology Manager 2225 TETON PLAZA SUITE B, IDAHO FALLS, ID 83404 2021-02-12

National Provider Identifier

NPI Number:
1639322258
Certification Date:
2021-08-17

Authorized Person:

Name:
DR. PETER W CASTELLANOS
Role:
NEUROLOGIST
Phone:

Taxonomy:

Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
No
Selected Taxonomy:
2084N0402X - Neurology with Special Qualifications in Child Neurology Physician
Is Primary:
Yes

Contacts:

Fax:
2088815121
Fax:
2085291627

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0004790988 2022-06-24
Annual Report 0004173880 2021-02-12
Annual Report 0003776166 2020-02-07
Annual Report 0003456715 2019-03-18
Annual Report 0001830590 2018-04-13

USAspending Awards / Financial Assistance

Date:
2021-03-24
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
31811.00
Total Face Value Of Loan:
31811.00
Date:
2020-04-28
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
28000.00
Total Face Value Of Loan:
28000.00

Paycheck Protection Program

Date Approved:
2021-03-24
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
31811
Current Approval Amount:
31811
Race:
White
Ethnicity:
Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
32097.3
Date Approved:
2020-04-27
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
28000
Current Approval Amount:
28000
Race:
White
Ethnicity:
Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
28273.1

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Date of last update: 26 Jun 2025

Sources: Idaho Secretary of State