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General NPI Number Information
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NPI Number | 1609699693
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Entity Type | Organization
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Legal Business Name | ANDRE'S HOUSE
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 1425 CAMBRIDGE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4209
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Country | US
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Telephone | 208-538-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 CAMBRIDGE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4209
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Country | US
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Telephone | 208-360-4647
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LARRY STANDFIELD JR.
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Credential |
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Telephone | 208-360-7608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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