South Park, Inc. in Pocatello - Intermediate Care Facility, Intellectual Disabilities
South Park, Inc. - NPI 1295954139
South Park, Inc. is a Intermediate Care Facility, Intellectual Disabilities in Pocatello, Idaho. South Park, Inc. practices all healthcare services and medical treatments related to Intermediate Care Facility, Intellectual Disabilities. The NPI Number for South Park, Inc. is 1295954139. The last update date is 2020-08-22.
South Park, Inc.'s current location address is 2369 Rulon Ave, Pocatello, Idaho. You can contact this provider via phone number 2082375538. The mailing address for South Park, Inc. is 2369 Rulon Ave, Pocatello, Idaho. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | South Park, Inc. |
|---|---|
| Address | 2369 Rulon Ave, Pocatello, Idaho |
| Phone Number | 2082375538 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | EXECUTIVE |
|---|---|
| Authorized Official Name | Mccoy C Russell |
| Credentials | M.A.ED |
| Telephone Number | 2082336833 |
NPI Number Detail
| NPI Number | 1295954139 |
|---|---|
| Provider Enumeration Date | 2007-04-25 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 2369 Rulon Ave |
|---|---|
| City | Pocatello |
| State | Idaho (ID) |
| Post Code | 832011881 |
| Phone Number | 2082375538 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Intermediate Care Facility, Intellectual Disabilities |
|---|---|
| Taxonomy | 315P00000X |
| Licence No | 259790 |
|
Definition: An intermediate care facility providing services for individuals with intellectual disabilities. |
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Post Comment/ Review Below
What is the unique identifier code issued to South Park, Inc. by the Centers for Medicare & Medicaid Services (CMS)?
The South Park, Inc. has been assigned the NPI (National Provider Identifier) 1295954139. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you please share the complete physical location address where South Park, Inc.'s facilities are situated?
The facilities of South Park, Inc. are physically located at the following address: 2369 Rulon Ave, Pocatello, ID, 832011881.
What is the South Park, Inc.'s specialty and taxonomy code?
The South Park, Inc.'s specialty is Intermediate Care Facility, Intellectual Disabilities, and the corresponding taxonomy code is 315P00000X.
On what date did the South Park, Inc. receive the assignment of its 1295954139 from the Centers for Medicare & Medicaid Services?
The South Park, Inc. was issued its 1295954139 by the Centers for Medicare & Medicaid Services on 2007-04-25.
As of what date was the information regarding South Park, Inc., such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to South Park, Inc., including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2020-08-22.