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Lily Pad Wellness LLC

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Company Details

Name: Lily Pad Wellness LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 12 Jul 2023 (2 years ago)
Financial Date End: 31 Jul 2026
Entity Number: 5317976
Place of Formation: IDAHO
File Number: 888211
ZIP code: 83201
County: Bannock County
Principal Address: A 1951 BENCH ROAD POCATELLO, ID 83201
Mailing Address: STE A 1951 BENCH RD POCATELLO, ID 83201-2073

Agent

Name Role Address
Stephanie A Clark Agent 1951 BENCH ROAD, SUITE A, POCATELLO, ID 83201

Manager

Name Role Address Appointed On
Stephanie A Clark Manager 1034 STRIPES RD, POCATELLO, ID 83202 2024-06-16

National Provider Identifier

NPI Number:
1275214660
Certification Date:
2023-07-27

Authorized Person:

Name:
STEPHANIE A CLARK
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2082166761

Filing

Filing Name Filing Number Filing date
Annual Report 0006319661 2025-06-16
Annual Report 0005781944 2024-06-16
Change of Registered Office/Agent/Both (by Entity) 0005328288 2023-07-20
Initial Filing 0005317976 2023-07-12

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Date of last update: 20 Jun 2025

Sources: Idaho Secretary of State