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Legacy Village Outpatient ID LLC

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Company Details

Name: Legacy Village Outpatient ID LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 25 May 2023 (2 years ago)
Financial Date End: 31 May 2024
Date dissolved: 13 Aug 2024
Entity Number: 5251224
Place of Formation: IDAHO
File Number: 880962
ZIP code: 83702
County: Ada County
Principal Address: 800 W MAIN ST STE 1460 BOISE, ID 83702
Mailing Address: STE 1460 800 W MAIN ST BOISE, ID 83702-5983

Agent

Name Role Address
UNITED STATES CORPORATION AGENTS INC Agent 800 W MAIN ST STE 1460, BOISE, ID 83702

National Provider Identifier

NPI Number:
1225721707
Certification Date:
2023-05-31

Authorized Person:

Name:
MR. DENNIS SCOTT FARMER
Role:
CHIEF EXECUTIVE OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
No
Selected Taxonomy:
324500000X - Substance Abuse Rehabilitation Facility
Is Primary:
Yes

Contacts:

Fax:
6614890573

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005858626 2024-08-13
Initial Filing 0005251224 2023-05-25

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Date of last update: 11 Jul 2025

Sources: Idaho Secretary of State