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Boise Brain and Body LLC

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Company Details

Name: Boise Brain and Body LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 31 May 2025 (3 months ago)
Financial Date End: 31 May 2026
Entity Number: 6290287
Place of Formation: IDAHO
File Number: 996779
ZIP code: 83854
County: Kootenai County
Principal Address: STE B 784 S. CLEARWATER LOOP POST FALLS, ID 83854
Mailing Address: STE B 784 S CLEARWATER LOOP POST FALLS, ID 83854-9599

Agent

Name Role Address
NORTHWEST REGISTERED AGENT LLC Agent 784 S CLEARWATER LOOP STE B, POST FALLS, ID 83854

National Provider Identifier

NPI Number:
1073403051
Certification Date:
2025-07-09

Authorized Person:

Name:
EDWARD ANTON
Role:
SOLE MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
2081P0301X - Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
Is Primary:
No
Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0006290287 2025-05-31

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Date of last update: 25 Aug 2025

Sources: Idaho Secretary of State