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  5. CENTENNIAL PEDIATRICS, P.C.

CENTENNIAL PEDIATRICS, P.C.

Company Details

Name: CENTENNIAL PEDIATRICS, P.C.
Jurisdiction: Colorado
Legal type: Domestic profit corporation
Status: Good Standing
Date of registration: 01 Jan 2004 (21 years ago)
Entity Number: 20031401601
ZIP code: 80016
County: Arapahoe County
Place of Formation: COLORADO
Principal Address: 15464 E Orchard Rd Centennial CO 80016 US

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
W3JXP8GQ6Z48 2024-10-12 15464 E ORCHARD RD, CENTENNIAL, CO, 80016, 3005, USA 15464 E ORCHARD RD, CENTENNIAL, CO, 80016, 3005, USA

Business Information
URL www.centennialpeds.com
Division Name CENTENNIAL PEDIATRICS, PC
Congressional District 06
State/Country of Incorporation CO, USA
Activation Date 2023-10-16
Initial Registration Date 2022-11-04
Entity Start Date 2004-07-04
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621999

Points of Contacts
Electronic Business
Title PRIMARY POC
Name MICHELLE K STANFORD
Address 15464 E. ORCHARD ROAD, CENTENNIAL, CO, 80016, USA
Government Business
Title PRIMARY POC
Name MICHELLE K STANFORD
Address 15464 E. ORCHARD ROAD, CENTENNIAL, CO, 80016, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2023 200490125 2024-10-15 CENTENNIAL PEDIATRICS, P.C. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing MICHELLE STANFORD
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2022 200490125 2023-10-09 CENTENNIAL PEDIATRICS, P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing MICHELLE STANFORD
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2021 200490125 2022-07-06 CENTENNIAL PEDIATRICS, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing MICHELLE STANFORD
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2020 200490125 2021-09-10 CENTENNIAL PEDIATRICS, P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Signature of
Role Plan administrator
Date 2021-09-10
Name of individual signing MICHELLE STANFORD
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2019 200490125 2020-07-22 CENTENNIAL PEDIATRICS, P.C. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2020-07-22
Name of individual signing PHIL TISUE
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2018 200490125 2019-06-18 CENTENNIAL PEDIATRICS, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6322 DEANE HILL DRIVE, SUITE 201, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2019-06-18
Name of individual signing PHIL TISUE
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2017 200490125 2018-08-22 CENTENNIAL PEDIATRICS, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6322 DEANE HILL DRIVE, SUITE 201, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2018-08-22
Name of individual signing PHIL TISUE
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2016 200490125 2017-10-02 CENTENNIAL PEDIATRICS, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6322 DEANE HILL DRIVE, SUITE 201, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2017-10-02
Name of individual signing PHIL TISUE
Valid signature Filed with authorized/valid electronic signature
CENTENNIAL PEDIATRICS, P.C. 401(K) PLAN 2015 200490125 2016-09-28 CENTENNIAL PEDIATRICS, P.C. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 3036805437
Plan sponsor’s address 15464 E. ORCHARD RD., CENTENNIAL, CO, 80016

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6322 DEANE HILL DRIVE, SUITE 201, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2016-09-28
Name of individual signing PHIL TISUE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Philip Stanford Agent 15464 E Orchard Rd Centennial CO 80016 US

Transaction History

Transaction ID Type Date Effective date Name Comment
20248346114 File Report 2024-12-23 2024-12-23 No data Change in registered agent information
20238345639 File Report 2023-12-27 2023-12-27 No data No data
20231257235 File Report 2023-03-03 2023-03-03 No data Principal address changed, Change in registered agent information
20221115114 File Report 2022-01-30 2022-01-30 No data No data
20211017117 File Report 2021-01-06 2021-01-06 No data No data
20201267370 File Report 2020-03-24 2020-03-24 No data No data
20191364561 File Report 2019-04-27 2019-04-27 No data No data
20181279223 File Report 2018-04-01 2018-04-01 No data No data
20171121186 File Report 2017-02-14 2017-02-14 No data No data
20161078105 File Report 2016-01-30 2016-01-30 No data No data

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 13 Jan 2025

Sources: Colorado's Secretary of State

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