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Broader Wellness, LLC

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Company Details

Name: Broader Wellness, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 07 Oct 2024 (9 months ago)
Financial Date End: 31 Oct 2025
Entity Number: 5931339
Place of Formation: IDAHO
File Number: 958380
ZIP code: 83706
County: Ada County
Principal Address: STACEY MARTINEZ 210A 3350 AMERICANA TERRACE BOISE, ID 83706
Mailing Address: PO BOX 6421 BOISE, ID 83707-6421

Agent

Name Role Address
STACEY MARTINEZ Agent 1815 S HELEN ST, BOISE, ID 83705

National Provider Identifier

NPI Number:
1689480030
Certification Date:
2024-12-09

Authorized Person:

Name:
STACEY MARTINEZ
Role:
LLC MEMBER/MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
Yes

Contacts:

Fax:
2089080034

Filing

Filing Name Filing Number Filing date
Initial Filing 0005931339 2024-10-07

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Date of last update: 22 Jun 2025

Sources: Idaho Secretary of State