Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

South Park, Inc

Organization Intellectual Disabilities Intermediate Care Facility · NPI 1134340011

South Park, Inc is an Intellectual Disabilities Intermediate Care Facility in Pocatello, Idaho. Licensed in Idaho. Registered with an NPI since 2007.

Licensed in
ID
In the registry since
2007
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3875 Bannock Hwy
Pocatello, ID 83204-4405
Phone: (208) 233-6844
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual Disabilities Intermediate Care Facility (primary) Taxonomy 315P00000X · Licence 00259800 (ID)

Record details

NPI number1134340011
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Russell McCoy — Executive Director · (208) 233-6833
Other names South Bannock Groupl Home
NPI enumeratedMay 1, 2007
Last updated in NPPESAugust 22, 2020
Mailing address415 S Arthur Ave, Pocatello, ID 83204-3303

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