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Dynovion Cognitive Wellness, LLC

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Company Details

Name: Dynovion Cognitive Wellness, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 30 Apr 2025 (4 months ago)
Financial Date End: 30 Apr 2026
Entity Number: 6225772
Place of Formation: IDAHO
File Number: 991655
Principal Address: DYNOVION COG WELLNESS STE 100 12550 W. EXPLORER DR BOISE, ID 83713
Mailing Address: DYNOVION COG WELLNESS 14233 SILVER RIDGE RD CALDWELL, ID 83607-5448

Agent

Name Role Address
Timothy Hoekstra Agent 14233 SILVER RIDGE RD, CALDWELL, ID 83607

National Provider Identifier

NPI Number:
1619760501
Certification Date:
2025-05-13

Authorized Person:

Name:
TIMOTHY J HOEKSTRA
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0006225772 2025-04-30

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Date of last update: 28 Jul 2025

Sources: Idaho Secretary of State