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TAPROOT MEDICINE, LLC

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Company Details

Legal Name: TAPROOT MEDICINE, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Delinquent
Formation/ Registration Date: March 13th 2016
Expiration date: 31 Mar 2025
UBI Number: 603 596 519
ZIP code: 98225
City: Bellingham
County: WHATCOM
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1108 11TH ST, STE 305, BELLINGHAM, WA, 98225-6623, UNITED STATES

Contact Details

E-Mail: JONATHAN@DELVECARE.COM
Phone Number: +1 360-605-0444

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
JONATHAN CARLSON Registered Agent 1108 11TH ST, STE 305, BELLINGHAM, WA, 98225-6623, UNITED STATES

Key Officers & Management

Name Role Address
JONATHAN CARLSON Governing Person 12533 42ND AVE NE #A, SEATTLE, WA, 98125, UNITED STATES
SARAH FORMICA Governing Person -

National Provider Identifier

NPI Number:
1144803735
Certification Date:
2021-04-30

Authorized Person:

Name:
DR. JONATHAN JAMES CARLSON
Role:
MEDICAL DIRECTOR, OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QM0850X - Adult Mental Health Clinic/Center
Is Primary:
Yes

Contacts:

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