NPI age
19 years
Enumerated 2007-02-12
● Active Type 2 · Organization
South Park, Inc.
South Park, Inc. is 1 of 303 case management organizations in Idaho.
Primary specialty
Case Management
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
McCoy
Executive Director
Last NPPES update
2025-09-11
Source: monthly bulk 2026-05
How this organization compares
Across 303 active case management providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
1
In the 16% of peers with subspecialties
NPI lifetime · 2007 → 2026
2007-02Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
415 S Arthur Ave
Pocatello, ID 832043303
Mailing address
415 S Arthur Ave
Pocatello, ID 832043303
Authorized official
Russell C McCoy, M.A.ED
Executive Director
📞 2082336833
Specialties
-
Case Management PrimaryAn organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management...
-
Intermediate Care Facility, Intellectual DisabilitiesAn intermediate care facility providing services for individuals with intellectual disabilities.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 00259810 | |
| 05 (ID) | 00259800 | |
| 05 (ID) | 00259790 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Developmental Options
Practice context
Single-site organization. Only one practice location on file.
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