FASA FAMILY WELLNESS PLLC

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Company Details

Legal Name:	FASA FAMILY WELLNESS PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Active
Formation/ Registration Date:	November 18th 2014
Expiration date:	30 Nov 2025
UBI Number:	603 453 683
ZIP code:	98512
City:	Olympia
County:	THURSTON
Home State:	WASHINGTON
Principal Office Street Address:	1610 BISHOP RD SW BLDG 7, TUMWATER, WA, 98512-7303, UNITED STATES
Principal Office Mailing Address:	3801 WAKE FOREST RD, #100, RALEIGH, NC, 27609-6864, UNITED STATES
Supporting healthcare providers fighting with COVID-19:	$404,874

Contact Details

E-Mail:	TAX@US-FAS.COM
Phone Number:	+1 360-754-3338

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name	Role
VCORP SERVICES, LLC	Registered Agent

Key Officers & Management

Name	Role
TERRENCE HESS	Governing Person
REED HAWES	Governing Person
CHRISTOPHER FORFAR	Governing Person

National Provider Identifier

NPI Number:

1659265734

Certification Date:

2025-06-04

Link:

View on NPI website

Authorized Person:

Name:

ROSALIE KREIGHBAUM

Role:

REGIONAL CREDENTIALING SPECIALIST

Phone:

3149091920

Taxonomy:

Selected Taxonomy:

332900000X - Non-Pharmacy Dispensing Site

Is Primary:

Yes

Contacts:

Phone:

+1 360-995-1836

Form 5500 Series

Employer Identification Number (EIN):

472330607

Plan Year:

2021

Number Of Participants:

91

Sponsor's telephone number:

3607543338

File:

Plan Administrator / Signatory:

BRYAN ALVAREZ(Plan administrator)

Plan Year:

2020

Number Of Participants:

65

Sponsor's telephone number:

3607543338

File:

Plan Administrator / Signatory:

BRYAN ALVAREZ(Plan administrator)

Plan Year:

2019

Number Of Participants:

54

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

3607543338

File:

Plan Administrator / Signatory:

JOELENE GIOULIS(Plan administrator)

Plan Year:

2018

Number Of Participants:

33

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

3607543338

File:

Plan Administrator / Signatory:

SARA HESS(Plan administrator)

Plan Year:

2017

Number Of Participants:

38

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

3607543338

File:

Plan Administrator / Signatory:

SARA HESS(Plan administrator)

Paycheck Protection Program

Jobs Reported:

74

Initial Approval Amount:

$760,780

Date Approved:

2020-04-10

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$760,780

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$770,733.54

Servicing Lender:

Commencement Bank

Use of Proceeds:

Payroll: $760,780

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