OrganizationActive
South Park, Inc.
NPI 1194930768 · Nursing Care Agency · Pocatello, ID
Provider details
- NPI number
- 1194930768
- Entity type
- Organization
- Primary specialty
- Nursing Care AgencyAgencies
- Organization subpart
- No
- Authorized official
- Russell Mccoy, Executive Director(208) 233-6833
Specialties & taxonomies
Agencies
Practice location
415 S Arthur Ave
Pocatello, ID 83204-3303
Phone: (208) 233-6833
Fax: (208) 233-6842
Approximate (ZIP-level) locationGet directions
Mailing address
415 S Arthur Ave
Pocatello, ID 83204-3303
Other names (DBA / former)
- Doing business as
- Developmental Options
Registry dates
- Enumerated
- 2007-05-14
- 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.