SOUTH PARK, INC. (NPI# 1295954139) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295954139 |
| Entity Type | Organization |
| Organization Name | SOUTH PARK, INC. |
| Other Organization Name | RULON HOUSE GROUP HOME |
| Practice Address |
2369 Rulon Ave Pocatello ID 83201-1881 |
| Mailing Address |
415 S Arthur Ave Pocatello ID 83204-3303 |
| Practice Telephone | 2082375538 |
| Mailing Telephone | 2082336833 |
| Mailing Fax Number | 2082336842 |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RUSSELL C MCCOY (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2082336833 |
| Authorized Official Credential | M.A.ED |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 00259790 | ID | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Rulon House Group Home | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134340011 | South Park, Inc. | Intermediate Care Facility, Mentally Retarded | 3875 Bannock Hwy, Pocatello, ID 83204-4405 | 2007-05-01 |
| 1205056538 | South Park, Inc. | Intermediate Care Facility, Mentally Retarded | 1722 Church Hill Downs, Pocatello, ID 83201 | 2007-04-27 |
| 1437291044 | South Park, Inc. | Case Management | 415 S Arthur Ave, Pocatello, ID 83204-3303 | 2007-02-12 |
| 1194930768 | South Park, Inc. | Nursing Care | 415 S Arthur Ave, Pocatello, ID 83204-3303 | 2007-05-14 |
| 1003021676 | South Park, Inc. | Case Management | 415 S Arthur Ave, Pocatello, ID 83204-3303 | 2007-05-14 |
| 1912112582 | South Park, Inc. | Case Management | 415 S Arthur Ave, Pocatello, ID 83204-3303 | 2007-05-14 |
| 1821203498 | South Park, Inc. | Case Management | 415 S Arthur Ave, Pocatello, ID 83204-3303 | 2007-05-14 |
| Street Address |
2369 RULON AVE |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-1881 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (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. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902110380 | Belmont Management, Inc. | Intermediate Care Facility, Mentally Retarded | 6150 S. 5th Ave, Pocatello, ID 83204 | 2010-07-28 |
| 1134340011 | South Park, Inc. | Intermediate Care Facility, Mentally Retarded | 3875 Bannock Hwy, Pocatello, ID 83204-4405 | 2007-05-01 |
| 1205056538 | South Park, Inc. | Intermediate Care Facility, Mentally Retarded | 1722 Church Hill Downs, Pocatello, ID 83201 | 2007-04-27 |
| 1922135789 | Belmont Management, Inc. | Intermediate Care Facility, Mentally Retarded | 4024 Mountain Loop, Pocatello, ID 83204-4951 | 2007-02-28 |
| 1285761148 | Belmont Management, Inc. | Intermediate Care Facility, Mentally Retarded | 3625 Vaughn Ave, Pocatello, ID 83204-2062 | 2007-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962755868 | State of Idaho | Intermediate Care Facility, Mentally Retarded | 1182 West Kyler Ave, Hayden, ID 83835 | 2012-10-17 |
| 1861742736 | Brenda Elaine Dilbeck | Intermediate Care Facility, Mentally Retarded | 4515 N Glenwood St, Boise, ID 83704-3012 | 2012-09-18 |
| 1760686687 | Idaho Falls Group Homes | Intermediate Care Facility, Mentally Retarded | 950 Periska Way, Idaho Falls, ID 83402-5141 | 2007-06-13 |
| 1235333576 | Idaho Falls Group Homes | Intermediate Care Facility, Mentally Retarded | 4360 Wanda St, Ammon, ID 83406-6878 | 2007-06-12 |
| 1447454798 | Idaho Falls Group Homes | Intermediate Care Facility, Mentally Retarded | 3612 Summit Run Trl, Idaho Falls, ID 83404-8247 | 2007-06-12 |
| 1730394644 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 11577 Freedom Dr, Boise, ID 83713-3650 | 2007-05-14 |
| 1013122928 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 10349 Summerwind Dr, Boise, ID 83704-3953 | 2007-05-14 |
| 1295948941 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 10528 W Milclay St, Boise, ID 83704-3940 | 2007-05-08 |
| 1487867123 | Independent Living Services, Inc. | Intermediate Care Facility, Mentally Retarded | 1736 N Five Mile Rd, Boise, ID 83713-5408 | 2007-05-08 |
| 1689896805 | Tomorrow's Hope Inc | Intermediate Care Facility, Mentally Retarded | 1655 Fairview Ave, Suite 100, Boise, ID 83702-0000 | 2007-05-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.