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CASCADE PARK SPORTS MEDICINE & REHAB CLINIC PLLC

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Company Details

Legal Name: CASCADE PARK SPORTS MEDICINE & REHAB CLINIC PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: March 7th 2011
Date of Dissolution: July 3rd 2012
Expiration date: 31 Mar 2012
UBI Number: 603 093 298
ZIP code: 98684
City: Vancouver
County: CLARK
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 12214 SE MILL PLAIN BLVD #101, VANCOUVER, WA, 98684, UNITED STATES

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Registered Agent Information

Name Role Address
LUCAS HOMER Registered Agent 12214 SE MILL PLAIN BLVD, SUITE 101, VANCOUVER, WA, 98684, UNITED STATES

Key Officers & Management

Name Role Address
LUCAS HOMER Governing Person 12214 SE MILL PLAIN BLVD, SUITE 101, VANCOUVER, WA, 98684, UNITED STATES

National Provider Identifier

NPI Number:
1679641393

Authorized Person:

Name:
LUCAS Q HOMER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
111N00000X - Chiropractor
Is Primary:
Yes

Contacts:

Fax:
3602537808
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