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North Idaho Detox LLC

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Company Details

Name: North Idaho Detox LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 17 Aug 2021 (4 years ago)
Financial Date End: 31 Aug 2024
Date dissolved: 15 Nov 2024
Entity Number: 4386700
Place of Formation: IDAHO
File Number: 777704
ZIP code: 83835
County: Kootenai County
Principal Address: 11933 N. EMERALD DR. HAYDEN, ID 83835
Mailing Address: 11933 N EMERALD DR HAYDEN, ID 83835-9424

Agent

Name Role Address
Chelsea R Mohr Agent 11933 N EMERALD DR, HAYDEN, ID 83835

Member

Name Role Address Appointed On
Jacob R. Siegberg Member 11933 N. EMERALD DR., HAYDEN, ID 83835 2022-08-01
Chelsea Raine Mohr Member 11933 N. EMERALD DR., HAYDEN, ID 83835 2021-10-04

National Provider Identifier

NPI Number:
1073267654
Certification Date:
2022-02-11

Authorized Person:

Name:
JACOB SIEGBERG
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
101YA0400X - Addiction (Substance Use Disorder) Counselor
Is Primary:
No
Selected Taxonomy:
251B00000X - Case Management Agency
Is Primary:
No
Selected Taxonomy:
261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center
Is Primary:
No
Selected Taxonomy:
276400000X - Substance Use Disorder Rehabilitation Hospital Unit
Is Primary:
No
Selected Taxonomy:
324500000X - Substance Abuse Rehabilitation Facility
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005982490 2024-11-15
Annual Report 0005374014 2023-08-29
Annual Report 0004836249 2022-08-01
Change of Registered Office/Agent/Both (by Entity) 0004459966 2021-10-25
Amendment to Certificate 0004428991 2021-10-04

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Date of last update: 08 Jul 2025

Sources: Idaho Secretary of State