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WESTERN CENTER FOR REHABILITATION PC

Company Details

Name: WESTERN CENTER FOR REHABILITATION PC
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 27 Oct 2004 (21 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 477099
Place of Formation: IDAHO
File Number: 477099
ZIP code: 83402
County: Bonneville County
Mailing Address: 955 PIER VIEW DR IDAHO FALLS, ID 83402-4918

Agent

Name Role Address
GUARDIAN REGISTERED AGENTS LLC Agent 955 PIER VIEW DR, IDAHO FALLS, ID 83402

National Provider Identifier

NPI Number:
1225180110

Authorized Person:

Name:
DR. SHANE CHRISTIAN MANGRUM
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
225400000X - Rehabilitation Practitioner
Is Primary:
Yes

Contacts:

Fax:
2085354344

Filing

Filing Name Filing Number Filing date
Annual Report 0005961621 2024-11-04
Annual Report 0005448923 2023-10-25
Annual Report 0004955620 2022-10-18
Annual Report 0004543855 2021-12-29
Annual Report 0004045668 2020-10-31

Date of last update: 12 May 2025

Sources: Idaho Secretary of State