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BLUE MOUNTAIN FAMILY HEALTH, PLLC

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Company Details

Legal Name: BLUE MOUNTAIN FAMILY HEALTH, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Other Names: BLUE MOUNTAIN FAMILY HEALTH
Status: Active
Formation/ Registration Date: October 1st 2005
Expiration date: 31 Oct 2025
UBI Number: 602 541 708
ZIP code: 99403
City: Clarkston
County: ASOTIN
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1268 BRIDGE ST, CLARKSTON, WA, 99403-2219, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $7,155

Contact Details

E-Mail: KEVINJBLACK@GMAIL.COM
Phone Number: +1 509-751-5500

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
KEVIN J BLACK Registered Agent 1268 BRIDGE ST, CLARKSTON, WA, 99403, UNITED STATES

Key Officers & Management

Name Role
ELIZABETH BLACK Governing Person
KEVIN BLACK Governing Person

National Provider Identifier

NPI Number:
1679649248
Certification Date:
2024-05-21

Authorized Person:

Name:
KEVIN JAMES BLACK
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
5097511059

Paycheck Protection Program

Jobs Reported:
3
Initial Approval Amount:
$27,900
Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$27,900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$28,091.1
Servicing Lender:
Umpqua Bank
Use of Proceeds:
Payroll: $27,900
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