VALLEY ROOTS FAMILY CARE, PLLC

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Company Details

Legal Name:	VALLEY ROOTS FAMILY CARE, PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Delinquent
Formation/ Registration Date:	June 8th 2021
Expiration date:	30 Jun 2025
UBI Number:	604 759 384
ZIP code:	98273
City:	Mount Vernon
County:	SKAGIT
Home State:	WASHINGTON
Principal Office Street Address:	617 W DIVISION ST, MOUNT VERNON, WA, 98273-3219, UNITED STATES
Principal Office Mailing Address:	PO BOX 2768, MOUNT VERNON, WA, 98273-7768, UNITED STATES

Contact Details

E-Mail:	DAVIDBENSONB@GMAIL.COM
Phone Number:	+1 360-428-1884

Nature of Business

Health Care, Social Assistance & Service Organization, MEDICAL CLINIC

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Registered Agent Information

Name	Role	Address
DAVID B BENSON MD PLLC	Registered Agent	617 W DIVISION ST, MOUNT VERNON, WA, 98273-3219, UNITED STATES

Key Officers & Management

Name	Role	Address
DAVID BENSON	Governing Person	-
DAVID B BENSON, MD	EXECUTOR	617 W DIVISION ST, MOUNT VERNON, WA, 98273-3219, UNITED STATES

National Provider Identifier

NPI Number:

1144693250

Certification Date:

2021-12-21

Link:

View on NPI website

Authorized Person:

Name:

TARA THOMAS

Role:

OFFICE MANAGER

Phone:

3604281884

Taxonomy:

Selected Taxonomy:

207Q00000X - Family Medicine Physician

Is Primary:

Yes

Contacts:

Phone:

+1 360-428-1884

Fax:

3604281889

Form 5500 Series

Employer Identification Number (EIN):

871116486

Plan Year:

2024

Number Of Participants:

12

Plan Name:

401(K)

Sponsor's telephone number:

3607071146

File:

Plan Administrator / Signatory:

DAVID BENSON(Plan administrator)

Plan Year:

2023

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

3607071146

File:

Plan Administrator / Signatory:

TARA THOMAS(Plan administrator)

Plan Year:

2022

Number Of Participants:

9

Plan Name:

401(K)

Sponsor's telephone number:

3607071146

Plan Administrator / Signatory:

TARA THOMAS(Plan administrator)

Plan Year:

2022

Number Of Participants:

9

Plan Name:

401(K)

Sponsor's telephone number:

3607071146

File:

Plan Administrator / Signatory:

TARA THOMAS(Plan administrator)

Plan Year:

2021

Number Of Participants:

11

Plan Name:

401(K)

Sponsor's telephone number:

3607071146

File:

Plan Administrator / Signatory:

TARA THOMAS(Plan administrator)

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