What is South Park, Inc.'s NPI number?

South Park, Inc.'s National Provider Identifier (NPI) is 1205056538, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.

What type of organization is South Park, Inc.?

South Park, Inc. is classified in the NPPES registry as Intellectual Disabilities Intermediate Care Facility (Nursing & Custodial Care Facilities).

Where is South Park, Inc. located?

South Park, Inc.'s practice location on file with NPPES is 1722 Church Hill Downs, Pocatello, ID 83201.

What is South Park, Inc.'s phone number?

The practice phone number listed in the NPPES registry for South Park, Inc. is (208) 237-2010.

Who is the authorized official for South Park, Inc.?

The authorized official listed on South Park, Inc.'s NPPES record is Russell Mccoy, Executive Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.

Is South Park, Inc.'s NPI active?

Yes — South Park, Inc.'s NPI (1205056538) is active in the NPPES registry as of the last update on 2020-08-22.

OrganizationActive

South Park, Inc.

NPI 1205056538 · Intellectual Disabilities Intermediate Care Facility · Pocatello, ID

South Park, Inc. is a Intellectual Disabilities Intermediate Care Facility organization in Pocatello, ID (NPI 1205056538).

Provider details

NPI number: 1205056538
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: 00259810 (ID)

Practice location

1722 Church Hill Downs

Pocatello, ID 83201

Phone: (208) 237-2010

Street-level locationGet directions

More ID providers

Mailing address

415 S Arthur Ave

Pocatello, ID 83204-3303

Specialties & taxonomies

Intellectual Disabilities Intermediate Care FacilityPrimary315P00000XLicense 00259810 (ID)
Nursing & Custodial Care Facilities

Other names (DBA / former)

Other name: Church Hill Downs Group Home

Profile Score

Detailed profile(90/100 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.

Enumerated: 2007-04-27
Last updated: 2020-08-22

Frequently asked questions

What is South Park, Inc.'s NPI number?: South Park, Inc.'s National Provider Identifier (NPI) is 1205056538, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
What type of organization is South Park, Inc.?: South Park, Inc. is classified in the NPPES registry as Intellectual Disabilities Intermediate Care Facility (Nursing & Custodial Care Facilities).
Where is South Park, Inc. located?: South Park, Inc.'s practice location on file with NPPES is 1722 Church Hill Downs, Pocatello, ID 83201.
What is South Park, Inc.'s phone number?: The practice phone number listed in the NPPES registry for South Park, Inc. is (208) 237-2010.
Who is the authorized official for South Park, Inc.?: The authorized official listed on South Park, Inc.'s NPPES record is Russell Mccoy, Executive Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
Is South Park, Inc.'s NPI active?: Yes — South Park, Inc.'s NPI (1205056538) is active in the NPPES registry as of the last update on 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.

Provider details

Practice location

Mailing address

Specialties & taxonomies

Other names (DBA / former)

Profile Score

Registry dates

Frequently asked questions

Specialties & taxonomies

Other names (DBA / former)

Profile Score

Frequently asked questions