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SOUTH PARK INC. NPI 1437291044


NPI Information

NPI: 1437291044
Provider Name: SOUTH PARK, INC.

Doing Business As: DEVELOPMENTAL OPTIONS

Classification: Case Management - 251B00000X
Entity Type: Organization

CLIA Number: 13D0699140

Address:
415 S ARTHUR AVE
POCATELLO, ID
ZIP 83204
Phone: (208) 233-6833
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SOUTH PARK, INC. is a case management in Pocatello, ID. The provider is an organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. SOUTH PARK, INC. NPI is 1437291044. The provider is registered as an organization entity type.
The provider Is Doing Business As Developmental Options.

The provider's business location address is:

415 S ARTHUR AVE
POCATELLO, ID
ZIP 83204-303
Phone: (208) 233-6833
Fax: (208) 233-6842

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 CLIA number assigned to this NPI record is 13D0699140 - intermediate care facility/individuals with intellectual disability with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/12/2007 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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251B00000XCase ManagementIDAHOYes
2315P00000XIntermediate Care Facility, Mentally Retarded15IDAHOX
3315P00000XIntermediate Care Facility, Mentally Retarded20IDAHOX
4315P00000XIntermediate Care Facility, Mentally Retarded43IDAHOX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100259790MEDICAIDIDAHO
200259800MEDICAIDIDAHO
300259810MEDICAIDIDAHO

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: 11/14/2023

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