NPI age
19 years
Enumerated 2007-04-25
● Active Type 2 · Organization
South Park, Inc.
South Park, Inc. is 1 of 58 intermediate care facility, intellectual disabilities organizations in Idaho.
Primary specialty
Intermediate Care Facility, Intellectual Disabilities
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
McCoy
Executive Director
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 58 active intermediate care facility, intellectual disabilities providers in Idaho.
NPI age
19 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-04Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
2369 Rulon Ave
Pocatello, ID 832011881
Mailing address
415 S Arthur Ave
Pocatello, ID 832043303
Authorized official
Russell C McCoy, M.A.ED
Executive Director
📞 2082336833
Specialties
-
Intermediate Care Facility, Intellectual Disabilities PrimaryAn intermediate care facility providing services for individuals with intellectual disabilities.
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Rulon House Group Home
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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