Provider Demographics
NPI:1982185260
Name:DOCTORS HOUSE CALLS, LLC
Entity Type:Organization
Organization Name:DOCTORS HOUSE CALLS, LLC
Other - Org Name:DOCTORS HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:208-985-2260
Mailing Address - Street 1:1552 N CRESTMONT DR STE B
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2193
Mailing Address - Country:US
Mailing Address - Phone:208-985-2260
Mailing Address - Fax:
Practice Address - Street 1:1552 N CRESTMONT DR STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2193
Practice Address - Country:US
Practice Address - Phone:208-985-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251E00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health