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Center for Lifetime Health, LLC

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Company Details

Name: Center for Lifetime Health, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 20 Jun 2023 (2 years ago)
Financial Date End: 30 Jun 2026
Entity Number: 5288296
Place of Formation: IDAHO
File Number: 884875
ZIP code: 83712
County: Ada County
Principal Address: 300 E. BANNOCK BOISE, ID 83712
Mailing Address: 111 W MAIN ST BOISE, ID 83702-7261

Agent

Name Role Address
Colleen M Shackelford Agent 111 W. MAIN STREET, 100, BOISE, ID 83702

Manager

Name Role Address Appointed On
Colleen Marie Shackelford Manager 5624 W. HILL ROAD, BOISE, ID 83703 2024-09-15

National Provider Identifier

NPI Number:
1689744963
Certification Date:
2023-07-25

Authorized Person:

Name:
COLLEEN SHACKELFORD
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
2083421879

Form 5500 Series

Employer Identification Number (EIN):
760762803
Plan Year:
2023
Number Of Participants:
13
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
9
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
10
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
8
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006243715 2025-05-07
Statement of Change of Business Mailing Address 0005900843 2024-09-15
Annual Report 0005900841 2024-09-15
Amendment to Certificate 0005383073 2023-09-06
Initial Filing 0005288296 2023-06-20

Paycheck Protection Program

Jobs Reported:
12
Initial Approval Amount:
$126,870
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$126,900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$128,231.58
Servicing Lender:
Idaho First Bank
Use of Proceeds:
Payroll: $126,900

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Date of last update: 11 Jul 2025

Sources: Idaho Secretary of State