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South Park, Inc. — NPI 1295954139, Pocatello, ID | NPI Central

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NPI 1295954139

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South Park, Inc.

NPI 1295954139 · Intellectual Disabilities Intermediate Care Facility · Pocatello, ID

Provider details

NPI number: 1295954139
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: 00259790 (ID)

Specialties & taxonomies

Intellectual Disabilities Intermediate Care FacilityPrimary315P00000XLicense 00259790 (ID)
Nursing & Custodial Care Facilities

Practice location

2369 Rulon Ave

Pocatello, ID 83201-1881

Phone: (208) 237-5538

Approximate (ZIP-level) locationGet directions

More ID providers

Mailing address

415 S Arthur Ave

Pocatello, ID 83204-3303

Other names (DBA / former)

Other name: Rulon House Group Home

Registry dates

Enumerated: 2007-04-25
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.