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General NPI Number Information
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NPI Number | 1982185260
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Entity Type | Organization
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Legal Business Name | DOCTORS HOUSE CALLS, LLC
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 1552 N CRESTMONT DR STE B
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City | MERIDIAN
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State | ID
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Zip | 83642-2193
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Country | US
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Telephone | 208-985-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 1552 N CRESTMONT DR STE B
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City | MERIDIAN
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State | ID
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Zip | 83642-2193
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Country | US
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Telephone | 208-985-2260
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CODY M FRESTON
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Credential | MBA
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Telephone | 208-985-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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