Healthcare Provider Details

I. General information

NPI: 1609699693
Provider Name (Legal Business Name): ANDRE'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 CAMBRIDGE DR
IDAHO FALLS ID
83401-4209
US

IV. Provider business mailing address

1425 CAMBRIDGE DR
IDAHO FALLS ID
83401-4209
US

V. Phone/Fax

Practice location:
  • Phone: 208-538-0610
  • Fax:
Mailing address:
  • Phone: 208-360-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY STANDFIELD JR.
Title or Position: PRESIDENT
Credential:
Phone: 208-360-7608