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Revitalize Medical Supply PLLC

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Company Details

Name: Revitalize Medical Supply PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 13 May 2021 (4 years ago)
Financial Date End: 31 May 2026
Entity Number: 4282645
Place of Formation: IDAHO
File Number: 763443
ZIP code: 83404
County: Bonneville County
Principal Address: WHITNEY FUNK 1680 ELK CREEK DR IDAHO FALLS, ID 83404

Agent

Name Role Address
WW Holdings llc Agent 4954 POWERHOUSE DR, IDAHO FALLS, ID 83406

Manager

Name Role Address Appointed On Resigned On
Whitney Funk Manager 4954 POWER HOUSE DRIVE, IDAHO FALLS, ID 83406 2022-04-22 2024-04-09
WW Holdings llc Manager 4954 POWERHOUSE DR, IDAHO FALLS, ID 83406 2025-04-03 No data

National Provider Identifier

NPI Number:
1508533209
Certification Date:
2025-01-17

Authorized Person:

Name:
WHITNEY WHITWORTH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
291U00000X - Clinical Medical Laboratory
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006185743 2025-04-03
Change of Registered Office/Agent/Both (by Entity) 0005819516 2024-07-15
Amendment to Certificate 0005819541 2024-07-15
Annual Report 0005686478 2024-04-09
Annual Report 0005175289 2023-04-03

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Date of last update: 19 May 2025

Sources: Idaho Secretary of State