OrganizationActive
South Park, Inc.
NPI 1134340011 · Intellectual Disabilities Intermediate Care Facility · Pocatello, ID
Provider details
- NPI number
- 1134340011
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Russell Mccoy, Executive Director(208) 233-6833
- License
- 00259800 (ID)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3875 Bannock Hwy
Pocatello, ID 83204-4405
Phone: (208) 233-6844
Street-level locationGet directions
Mailing address
415 S Arthur Ave
Pocatello, ID 83204-3303
Other names (DBA / former)
- Other name
- South Bannock Groupl Home
Registry dates
- Enumerated
- 2007-05-01
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.