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Pivotal Whole Health Group LLC

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Company Details

Name: Pivotal Whole Health Group LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 16 Jan 2021 (4 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 4136740
Place of Formation: IDAHO
File Number: 742657
ZIP code: 83814
County: Kootenai County
Principal Address: 916 WEST IRONWOOD COEUR D ALENE, ID 83814
Mailing Address: 1581 E EDMONDTON AVE POST FALLS, ID 83854-6188

Agent

Name Role Address
Drew A Johnson Agent 1581 E EDMONTON AVE, POST FALLS, ID 83854

Manager

Name Role Address Appointed On
Drew A Johnson Manager 12473 EAST NUNN ROAD, ATHOL, ID 83801 2022-01-21

National Provider Identifier

NPI Number:
1588247092
Certification Date:
2021-11-08

Authorized Person:

Name:
DR. KAREN STANEK
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2089664947

Filing

Filing Name Filing Number Filing date
Annual Report 0006068563 2025-01-13
Annual Report 0005509384 2023-12-12
Annual Report 0005074529 2023-01-18
Amendment to Certificate 0004674468 2022-03-28
Annual Report 0004583859 2022-01-28

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Date of last update: 15 Jun 2025

Sources: Idaho Secretary of State