| Name: | Cottonwood Creek Clinic, LLC |
| Jurisdiction: | Alaska |
| Legal type: | Limited Liability Company |
| Status: | Good Standing |
| Date of registration: | 07 Oct 2014 (10 years ago) |
| Entity Number: | 10024033 |
| ZIP code: | 99654 |
| County: | Matanuska Susitna |
| Place of Formation: | ALASKA |
| Address: | 3600 E WICKERSHAM WAY, WASILLA, AK 99654 |
| Supporting healthcare providers fighting with COVID-19: | $33,604 |
Line of Business
62 Health Care and Social AssistanceNAICS
621111 OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)| Name | Role |
|---|---|
| Richard W Blake | Member |
| Richard Blake | Registered Agent |
| Unique Entity ID | Expiration Date | Physical Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| UWR2LREEP9H1 | 2021-11-12 | 3600 E WICKERSHAM WAY, WASILLA, AK, 99654, 7550, USA | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Congressional District | 00 |
| State/Country of Incorporation | AK, USA |
| Activation Date | 2020-11-16 |
| Initial Registration Date | 2020-02-12 |
| Entity Start Date | 2014-10-07 |
| Fiscal Year End Close Date | Dec 19 |
Service Classifications
| NAICS Codes | 621111, 621399 |
| Product and Service Codes | Q201 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | DAWN H GIEGERICH |
| Role | CLINIC MANAGER |
| Address | 3600 E WICKERSHAM WAY, WASILLA, AK, 99654, 7550, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | DAWN H GIEGERICH |
| Role | CLINIC MANAGER |
| Address | 3600 E WICKERSHAM WAY, WASILLA, AK, 99654, 7550, USA |
| Past Performance | - |
|---|
| License Number | Type | Status | Issue Date | Date of renewal | Expiration date | Description |
|---|---|---|---|---|---|---|
| 1011473 | Business License | Active | 2014-10-09 | 2024-10-08 | 2026-12-31 | LOB: 62 - Health Care and Social Assistance, NAICS: 621111 - OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS) |
| License Number | Program | Type | Status | Issue Date | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|
| 159167 | Telemedicine Business Registry | Telemedicine Business Registry | Active | 2020-03-20 | 2020-03-20 | - |
Date of last update: 02 Feb 2025
Sources: State of Alaska - Department of Commerce, Community, and Economic Development
