South Park, Inc.
NPI #1205056538 in Pocatello, Idaho
Provider Information
- NPI Number
- 1205056538
- Entity Type
- Organization
- Organization Name
- South Park, Inc.
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Apr 27, 2007
- Last Updated
- Aug 22, 2020
Practice Location
Authorized Official
- Name
- RUSSELL C MCCOY, M.A.ED
- Title
- EXECUTIVE DIRECTOR
- Phone
- (208) 233-6833
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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