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WESTERN CENTER FOR REHABILITATION PC

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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

President

Name Role Address Appointed On
Shane Mangrum President 1090 CHANTILLY DR., ALPHARETTA, GA 30004 2020-10-31

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

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Date of last update: 10 Aug 2025

Sources: Idaho Secretary of State