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Oak & Bloom Wellness LLC

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Company Details

Name: Oak & Bloom Wellness LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 10 Apr 2025 (3 months ago)
Financial Date End: 30 Apr 2026
Entity Number: 6203365
Place of Formation: IDAHO
File Number: 987927
ZIP code: 83706
County: Ada County
Principal Address: 1328 E. INDEPENDENCE ST. BOISE, ID 83706
Mailing Address: 1328 E INDEPENDENCE ST BOISE, ID 83706-5625

Agent

Name Role Address
Natalia Samudovsky Agent 1328 E INDEPENDENCE ST, BOISE, ID 83706-5625

National Provider Identifier

NPI Number:
1255120804
Certification Date:
2025-05-01

Authorized Person:

Name:
NATALIA SAMUDOVSKY
Role:
THERAPIST/COUNSELOR
Phone:

Taxonomy:

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

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0006203365 2025-04-10

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Date of last update: 22 Jun 2025

Sources: Idaho Secretary of State