SPOKANE PSYCHIATRIC CLINIC, PS

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Company Details

Legal Name:	SPOKANE PSYCHIATRIC CLINIC, PS
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL SERVICE CORPORATION
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	December 8th 2006
Date of Dissolution:	May 1st 2017
Expiration date:	31 Dec 2016
UBI Number:	602 675 305
ZIP code:	99201
City:	Spokane
County:	SPOKANE
Home State:	WASHINGTON
Principal Office Street Address:	717 W SPRAGUE AVE, SUITE 1200, SPOKANE, WA, 99201, UNITED STATES

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Registered Agent Information

Name	Role	Address
MARK CHALEM	Registered Agent	201 W NORTH RIVER DR STE 520, SPOKANE, WA, 99201-2262, UNITED STATES

Key Officers & Management

Name	Role	Address
MARK CHALEM	Governing Person	105 W 8TH #6055, SPOKANE, WA, 99204, UNITED STATES
BILL BROWN	Governing Person	105 W 8TH #6055, SPOKANE, WA, 99204, UNITED STATES
DAVID BOT	Governing Person	105 W 8TH #6055, SPOKANE, WA, 99204, UNITED STATES
JAY SCHMAUCH	Governing Person	105 W 8TH #6055, SPOKANE, WA, 99204, UNITED STATES

National Provider Identifier

NPI Number:

1235293473

Link:

View on NPI website

Authorized Person:

Name:

JERENE G ROCKSTROM

Role:

OFFICE MANAGER

Phone:

5094559090

Taxonomy:

Selected Taxonomy:

2084P0800X - Psychiatry Physician

Is Primary:

No

Selected Taxonomy:

2084P0800X - Psychiatry Physician

Is Primary:

No

Selected Taxonomy:

2084P0800X - Psychiatry Physician

Is Primary:

No

Selected Taxonomy:

2084P0800X - Psychiatry Physician

Is Primary:

No

Selected Taxonomy:

2084P0800X - Psychiatry Physician

Is Primary:

Yes

Contacts:

Phone:

+1 509-455-9090

Fax:

5097472118

Form 5500 Series

Employer Identification Number (EIN):

911551956

Plan Year:

2016

Number Of Participants:

0

Plan Name:

401(K)

Sponsor's telephone number:

5094559090

File:

Plan Year:

2016

Number Of Participants:

0

Plan Name:

401(K)

Sponsor's telephone number:

5094559090

File:

Plan Administrator / Signatory:

DOMONIQUE PERETTI(Plan administrator)

Plan Year:

2015

Number Of Participants:

15

Plan Name:

401(K)

Sponsor's telephone number:

5094559090

File:

Plan Administrator / Signatory:

BETH ELFERING(Plan administrator)

Plan Year:

2014

Number Of Participants:

15

Plan Name:

401(K)

Sponsor's telephone number:

5094559090

File:

Plan Administrator / Signatory:

ELIZABETH ELFERING(Plan administrator)

Plan Year:

2013

Number Of Participants:

14

Plan Name:

401(K)

Sponsor's telephone number:

5094559090

File:

Plan Administrator / Signatory:

AMY MOSSMAN(Plan administrator)

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717 W SPRAGUE AVE, SUITE 1200, SPOKANE, WA, 99201, UNITED STATES

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