Provider Demographics
NPI:1154877918
Name:BOISE HOUSE CALLS, LLC
Entity type:Organization
Organization Name:BOISE HOUSE CALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:MARICLE-KUWAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:208-484-6703
Mailing Address - Street 1:303 ELK CREEK ROAD
Mailing Address - Street 2:PO BOX 88
Mailing Address - City:IDAHO CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83631
Mailing Address - Country:US
Mailing Address - Phone:208-484-6703
Mailing Address - Fax:208-392-4128
Practice Address - Street 1:303 ELK CREEK ROAD
Practice Address - Street 2:SUITE BOX 88
Practice Address - City:IDAHO CITY
Practice Address - State:ID
Practice Address - Zip Code:83631
Practice Address - Country:US
Practice Address - Phone:208-848-6703
Practice Address - Fax:208-392-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 289261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804161900Medicaid
ID804161900Medicaid