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NORTHWEST KETAMINE CLINICS TACOMA PLLC

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Company Details

Legal Name: NORTHWEST KETAMINE CLINICS TACOMA PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Voluntarily Dissolved
Formation/ Registration Date: September 16th 2020
Date of Dissolution: April 8th 2025
Expiration date: 30 Sep 2025
UBI Number: 604 526 656
ZIP code: 98405
City: Tacoma
County: PIERCE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1901 S UNION AVE STE 4001, TACOMA, WA, 98405-1702, UNITED STATES
Principal Office Mailing Address: Google Maps Logo 35302 SE CENTER ST, SNOQUALMIE, WA, 98065-9216, UNITED STATES

Contact Details

E-Mail: ALLYN@ADVANCEDANESTHESIASERVICES.COM
Phone Number: +1 206-309-2299

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
ALLYN WILCOCK Registered Agent 1901 S UNION AVE STE 4001, TACOMA, WA, 98405-1702, UNITED STATES

Key Officers & Management

Name Role Address
ALLYN WILCOCK Executor 35302 SE CENTER ST, SNOQUALMIE, WA, 98065-9216, UNITED STATES
CHRISTINE WILCOCK Executor 35302 SE CENTER ST, SNOQUALMIE, WA, 98065-9216, UNITED STATES
ALLYN WILCOCK Governing Person 1901 S UNION AVE STE 4001, TACOMA, WA, 98405-1702, UNITED STATES
CHRISTINE WILCOCK Governing Person 1901 S UNION AVE STE 4001, TACOMA, WA, 98405-1702, UNITED STATES

National Provider Identifier

NPI Number:
1215528732
Certification Date:
2021-01-27

Authorized Person:

Name:
ALLYN D WILCOCK
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
4252563250

Form 5500 Series

Employer Identification Number (EIN):
853292068
Plan Year:
2024
Number Of Participants:
9
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
QIAN LIU(Plan administrator)
Plan Year:
2023
Number Of Participants:
6
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
QIAN LIU(Plan administrator)
Plan Year:
2022
Number Of Participants:
0
Plan Name:
401(K)
Sponsor's telephone number:
Plan Administrator / Signatory:
CHRISTINE RIMER(Plan administrator)
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