OrganizationActive
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
Nursing & Custodial Care Facilities
Practice location
2369 Rulon Ave
Pocatello, ID 83201-1881
Phone: (208) 237-5538
Approximate (ZIP-level) locationGet directions
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.