NPI 1003021676

South Park, INC.

Organisation Case Management Agency Pocatello, ID

Practice location

Address: 415 S Arthur Ave, Pocatello, ID 83204-3303
Phone: (208) 233-6833
Fax: (208) 233-6842

Authorised official

Name: Russell C McCoy
Title: Executive Director
Phone: (208) 233-6833

Registered specialties

Case Management Agency Primary

Agencies Taxonomy 251B00000X

Other Case Management providers in Idaho →

Registry record

NPI: 1003021676
Entity type: Organization
NPI issued: 14 May 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.