South Park, Inc.

NPI #1003021676 in Pocatello, Idaho

Provider Information

NPI Number: 1003021676
Entity Type: Organization
Organization Name: South Park, Inc.
Primary Specialty: Case Management
Enumeration Date: May 14, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 415 S ARTHUR AVE
City: Pocatello
State: Idaho
ZIP Code: 83204-3303
Phone: (208) 233-6833

Authorized Official

Name: RUSSELL C MCCOY, M.A.ED
Title: EXECUTIVE DIRECTOR
Phone: (208) 233-6833

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Management	251B00000X	Primary

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