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WELLSPRING BEHAVIORAL HEALTH, PC

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Company Details

Name: WELLSPRING BEHAVIORAL HEALTH, PC
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 11 Jul 2016 (9 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 628189
Place of Formation: IDAHO
File Number: 628189
ZIP code: 83616
County: Ada County
Mailing Address: DR. ASHLEY CROFT STE 150 951 E PLAZA DR EAGLE, ID 83616-6567

Agent

Name Role Address
ASHLEY J CROFT Agent 951 E PLAZA DR., STE 150, EAGLE, ID 83616

Director

Name Role Address Appointed On Resigned On
Glen J Croft Director 2339 W. CLEAR CREEK DR., EAGLE, ID 83616 2020-07-22 2022-06-23

President

Name Role Address Appointed On
Ashley Croft President 951 E PLAZA DR, EAGLE, ID 83616-6567 2024-07-09

National Provider Identifier

NPI Number:
1124642293
Certification Date:
2020-06-03

Authorized Person:

Name:
DR. ASHLEY CROFT
Role:
OWNER/PROVIDER
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2089382897

Form 5500 Series

Employer Identification Number (EIN):
813161750
Plan Year:
2024
Number Of Participants:
11
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
0
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0005813721 2024-07-09
Application for Reinstatement 0005489674 2023-11-29
Change of Registered Office/Agent/Both (by Entity) 0005489466 2023-11-28
Statement of Change of Business Mailing Address 0005489456 2023-11-28
Dissolution/Revocation - Administrative 0005428650 2023-10-04

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Date of last update: 05 Jul 2025

Sources: Idaho Secretary of State