South Park, Inc.

NPI #1295954139 in Pocatello, Idaho

Provider Information

NPI Number
1295954139
Entity Type
Organization
Organization Name
South Park, Inc.
Primary Specialty
Intermediate Care Facility, Intellectual Disabilities
Enumeration Date
Apr 25, 2007
Last Updated
Aug 22, 2020

Practice Location

Address
2369 RULON AVE
State
Idaho
ZIP Code
83201-1881
Phone
(208) 237-5538

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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