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Snake River Mental Health PLLC

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Company Details

Name: Snake River Mental Health PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 22 Nov 2024 (8 months ago)
Financial Date End: 30 Nov 2025
Entity Number: 5992323
Place of Formation: IDAHO
File Number: 965233
ZIP code: 83676
County: Canyon County
Principal Address: 15821 ALLENDALE ROAD WILDER, ID 83676
Mailing Address: 15821 ALLENDALE RD WILDER, ID 83676-5864

Agent

Name Role Address
Gordon Bradley Greaves Agent 15821 ALLENDALE ROAD, WILDER, ID 83676

National Provider Identifier

NPI Number:
1497565832
Certification Date:
2025-04-14

Authorized Person:

Name:
GORDON BRADLEY GREAVES
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

Fax:
2086213128

Filing

Filing Name Filing Number Filing date
Initial Filing 0005992323 2024-11-22

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Date of last update: 12 Jul 2025

Sources: Idaho Secretary of State