SOUTH PARK INC. NPI 1295954139

NPI Information

NPI: 1295954139
Provider Name: SOUTH PARK, INC.

Other Name: RULON HOUSE GROUP HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
2369 RULON AVE
POCATELLO, ID
ZIP 83201
Phone: (208) 237-5538
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SOUTH PARK, INC. is an intermediate care facility mentally retarded in Pocatello, ID. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. SOUTH PARK, INC. NPI is 1295954139. The provider is registered as an organization entity type.
The provider Other Name Is Rulon House Group Home.

The provider's business location address is:

2369 RULON AVE
POCATELLO, ID
ZIP 83201-881
Phone: (208) 237-5538

The provider's authorized official is Russell C Mccoy .
The authorized official title is Executive Director and has the following contact phone number (208) 233-6833.

The enumeration date for this NPI number is 4/25/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		00259790	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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