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Transformed Mind and Body LLC

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Company Details

Name: Transformed Mind and Body LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 11 Sep 2024 (9 months ago)
Financial Date End: 30 Sep 2025
Entity Number: 5897711
Place of Formation: IDAHO
File Number: 954708
ZIP code: 83716
County: Elmore County
Principal Address: 8040 S RED CLIFF AVE BOISE, ID 83716
Mailing Address: 8040 S RED CLIFF AVE BOISE, ID 83716-3466

Agent

Name Role Address
Jennefir Digaum Agent 8040 S RED CLIFF AVE, BOISE, ID 83716

National Provider Identifier

NPI Number:
1063230449
Certification Date:
2024-09-30

Authorized Person:

Name:
JONIRUTH DIGAUM
Role:
NURSE PRACTITIONER
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0005897711 2024-09-11

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Date of last update: 23 May 2025

Sources: Idaho Secretary of State