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Cherry Heights Family Clinic, LLC

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Company Details

Name: Cherry Heights Family Clinic, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 04 Aug 2021 (4 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 4369883
Place of Formation: IDAHO
File Number: 775875
ZIP code: 83642
County: Ada County
Principal Address: CODY FRESTON 1560 N. CRESTMONT DRIVE MERIDIAN, ID 83642
Mailing Address: CODY FRESTON STE A 1560 N CRESTMONT DR MERIDIAN, ID 83642-2178

Agent

Name Role Address
Cody Freston Agent 1560 N CRESTMONT DRIVE, MERIDIAN, ID 83642

Member

Name Role Address Appointed On
Cody Freston Member 1552 NORTH CRESTMONT DRIVE, MERIDIAN, ID 83642 2022-12-12

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
HEARSU41VHG3
CAGE Code:
9M5X4
UEI Expiration Date:
2026-03-31

Business Information

Division Name:
CHERRY HEIGHTS FAMILY CLINIC
Activation Date:
2025-04-02
Initial Registration Date:
2023-06-22

National Provider Identifier

NPI Number:
1952078115
Certification Date:
2024-11-01

Authorized Person:

Name:
TAHLIA DENNIS
Role:
DELEGATED OFFICIAL
Phone:

Taxonomy:

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

Contacts:

Fax:
2086504892

Filing

Filing Name Filing Number Filing date
Annual Report 0005891964 2024-09-06
Annual Report 0005346603 2023-08-03
Application for Reinstatement 0005012313 2022-12-12
Dissolution/Revocation - Administrative 0004979582 2022-11-05
Initial Filing 0004369883 2021-08-04

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Date of last update: 16 Jun 2025

Sources: Idaho Secretary of State