Provider Demographics
NPI:1609699693
Name:ANDRE'S HOUSE
Entity type:Organization
Organization Name:ANDRE'S HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:208-360-7608
Mailing Address - Street 1:1425 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4209
Mailing Address - Country:US
Mailing Address - Phone:208-360-4647
Mailing Address - Fax:
Practice Address - Street 1:1425 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4209
Practice Address - Country:US
Practice Address - Phone:208-538-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDRE'S HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker