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Keystone Center for Geriatrics LLC

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Company Details

Name: Keystone Center for Geriatrics LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 14 Jun 2021 (4 years ago)
Financial Date End: 30 Jun 2026
Entity Number: 4314997
Place of Formation: IDAHO
File Number: 768173
ZIP code: 83616
County: Ada County
Principal Address: STE 170 868 E RIVERSIDE DR EAGLE, ID 83616
Mailing Address: 305 W BANNOCK ST BOISE, ID 83702-6033

Managing Member

Name Role Address Appointed On
Leonard Jensen Managing Member 2575 N TANGLEROSE PL, EAGLE, ID 83616 2025-05-13

Agent

Name Role Address
LEONARD JENSEN Agent 2575 N TANGLEROSE PL, EAGLE, ID 83616

Manager

Name Role Address Appointed On Resigned On
Marianne Jensen Manager 2575 N TANGLEROSE PL, EAGLE, ID 83616 2024-05-15 2024-05-15

Member

Name Role Address Appointed On
Leonard Jensen Member 2575 N TANGLEROSE PL, EAGLE, ID 83616 2022-11-09

National Provider Identifier

NPI Number:
1376211268
Certification Date:
2021-09-03

Authorized Person:

Name:
MR. LEONARD RICHARD JENSEN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207QG0300X - Geriatric Medicine (Family Medicine) Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006253179 2025-05-13
Annual Report 0005738109 2024-05-15
Annual Report 0005220028 2023-05-03
Application for Reinstatement 0004988536 2022-11-09
Dissolution/Revocation - Administrative 0004914990 2022-09-15

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Date of last update: 19 May 2025

Sources: Idaho Secretary of State