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Drake Rehabilitation Outcomes PLLC

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Company Details

Name: Drake Rehabilitation Outcomes PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Feb 2021 (4 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 4178655
Place of Formation: IDAHO
File Number: 748530
ZIP code: 83706
County: Ada County
Principal Address: 2656 S HARMONY ST BOISE, ID 83706
Mailing Address: 2656 S HARMONY AVE BOISE, ID 83706-5053

Agent

Name Role Address
LEGALINC CORPORATE SERVICES INC. Agent 800 W MAIN ST STE 1460, BOISE, ID 83702

Member

Name Role Address Appointed On Resigned On
Grant Drake Member 8401 NW 107TH CT, UNIT 6, DORAL, FL 33178 2022-01-04 No data
Sophanna Drake Member 2656 S HARMONY ST, BOISE, ID 83706 2024-01-12 2024-01-12

National Provider Identifier

NPI Number:
1639749534
Certification Date:
2021-07-01

Authorized Person:

Name:
GRANT DRAKE
Role:
OWNER/PROVIDER
Phone:

Taxonomy:

Selected Taxonomy:
2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006096082 2025-02-04
Annual Report 0005560827 2024-01-12
Annual Report 0005205705 2023-04-19
Annual Report 0004552728 2022-01-04
Initial Filing 0004178655 2021-02-19

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Date of last update: 08 Jul 2025

Sources: Idaho Secretary of State