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South Park, Inc.
Intellectual Disabilities Intermediate Care Facility in Pocatello, Idaho
NPI 1295954139

South Park, Inc. is a Intellectual Disabilities Intermediate Care Facility based in Pocatello, ID. South Park, Inc. practices in Pocatello, ID. The NPI Number for South Park, Inc. is 1295954139 and holds a License No. 00259790 (Idaho).

The current practice location address for South Park, Inc. is 2369 Rulon Ave, Pocatello, ID and can be reached out via phone at 208-237-5538.

Location: 2369 Rulon Ave, Pocatello, ID, 83204-3303
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1295954139
Provider Name
South Park, Inc.
Credential
Provider Entity Type
Organization
Address
2369 Rulon Ave, Pocatello, ID, 83204-3303
Phone Number
208-237-5538
Fax Number
Provider Enumeration Date
04/25/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2369 Rulon Ave
City
Pocatello
State
Idaho
Zip
83201-1881
Phone Number
208-237-5538
Fax Number
person
Provider Business Mailing Address Details
Address
2369 Rulon Ave
City
Pocatello
State
Idaho
Zip
83201-1881
Phone Number
208-237-5538
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
00259790 (Idaho)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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