Organization
SOUTH PARK, INC.
Active
Other names
Developmental Options
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL C MCCOY M.A.ED (EXECUTIVE DIRECTOR)
(208) 233-6833
Entity
Organization
Contact information
Practice address
415 S ARTHUR AVE, POCATELLO, ID 83204-3303
(208) 233-6833
(208) 233-6842
Mailing address
415 S ARTHUR AVE, POCATELLO, ID 83204-3303
(208) 233-6833
(208) 233-6842
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
ID
Other
Enumeration date
05/14/2007
Last updated
08/22/2020
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