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CC POCATELLO, LLC

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Company Details

Name: CC POCATELLO, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 23 May 2016 (9 years ago)
Financial Date End: 31 May 2026
Entity Number: 505593
Place of Formation: IDAHO
File Number: 505593
ZIP code: 83404
County: Bonneville County
Principal Address: 2325 CORONADO STREET IDAHO FALLS, ID 83404

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 1305 12TH AVE RD, NAMPA, ID 83686

Manager

Name Role Address Appointed On Resigned On
MARK HALL Manager 2325 CORONADO STREET, IDAHO FALLS, ID 83404 2021-05-05 2024-05-08
Mark Hall Manager 2325 CORONADO STREET, IDAHO FALLS, ID 83404 2024-05-08 No data

National Provider Identifier

NPI Number:
1538517156

Authorized Person:

Name:
JOSHUA TOLMAN
Role:
CAO
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006188909 2025-04-04
Annual Report 0005730412 2024-05-08
Annual Report 0005222613 2023-05-04
Annual Report 0004740836 2022-05-10
Registered Agent Name/Address Change (mass change) 0004640300 2022-03-08

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Date of last update: 06 Jun 2025

Sources: Idaho Secretary of State