SOUTH PARK, INC. (NPI# 1437291044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437291044 |
| Entity Type | Organization |
| Organization Name | SOUTH PARK, INC. |
| Other Organization Name | DEVELOPMENTAL OPTIONS |
| Practice Address |
415 S Arthur Ave Pocatello ID 83204-3303 |
| Practice Telephone | 2082336833 |
| Practice Fax Number | 2082336842 |
| Mailing Telephone | 2082336833 |
| Mailing Fax Number | 2082336842 |
| Enumeration Date | 2007-02-12 |
| 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 |
|---|---|---|---|---|---|
| X | 251B00000X | Case Management | ID | Agencies | |
| X | 315P00000X | Intermediate Care Facility, Mentally Retarded | 15 | ID | Nursing & Custodial Care Facilities |
| X | 315P00000X | Intermediate Care Facility, Mentally Retarded | 20 | ID | Nursing & Custodial Care Facilities |
| X | 315P00000X | Intermediate Care Facility, Mentally Retarded | 43 | ID | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 00259790 | 05 | |
| ID | 00259800 | 05 | |
| ID | 00259810 | 05 |
| Other Name | Type Code |
|---|---|
| Developmental Options | Doing Business As Name - 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 |
| 1295954139 | South Park, Inc. | Intermediate Care Facility, Mentally Retarded | 2369 Rulon Ave, Pocatello, ID 83201-1881 | 2007-04-25 |
| 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 |
415 S ARTHUR AVE |
| City | POCATELLO |
| State | ID |
| Zip Code | 83204-3303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568974541 | Daniel Graham Rasmussen | Social Worker | 335 N. Main, Pocatello, ID 83204 | 2017-10-30 |
| 1801311246 | Thomas Henrie | Specialist/Technologist | 3960 Stockman Rd., Pocatello, ID 83204 | 2017-08-07 |
| 1750803110 | David Tim Williams | Counselor | 224 S. Arthur Suite 2, Pocatello, ID 83204 | 2017-07-07 |
| 1023441185 | Insight Occupational Therapy, LLC | Occupational Therapist | 158 N Main St., Pocatello, ID 83204 | 2013-08-13 |
| 1679816912 | A New Hope, LLC | Day Training, Developmentally Disabled Services | 19b Mountain Dr, Pocatello, ID 83204 | 2013-04-05 |
| 1790032431 | Wynnona Sarah Warren | Pharmacist | 911 North Main Street, Pocatello, ID 83204 | 2012-08-13 |
| 1902110380 | Belmont Management, Inc. | Intermediate Care Facility, Mentally Retarded | 6150 S. 5th Ave, Pocatello, ID 83204 | 2010-07-28 |
| 1104066539 | Rachel Ann Seibold | Speech-Language Pathologist | 1254 Swisher Rd, Pocatello, ID 83204 | 2009-02-25 |
| 1710163803 | Allen Bennett Martin | Clinic/Center | 540 South Garfield, Pocatello, ID 83204 | 2008-01-18 |
| 1174711758 | Rsm Pa Pllc | Physician Assistant | 1595 Bannock Hwy, Pocatello, ID 83204 | 2007-10-09 |
| Find all providers in zip 83204 | ||||
| Taxonomy Code | 251B00000X |
| Grouping | Agencies |
| Classification | Case Management |
| An 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 services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265033484 | Ala, LLC | Case Management | 818 E Lander St, Pocatello, ID 83201-5763 | 2020-11-04 |
| 1316551187 | Atropos Mental Health | Case Management | 217 S 9th Ave, Pocatello, ID 83201-5351 | 2020-08-31 |
| 1013431816 | Gem Prep: Pocatello, Inc. | Case Management | 1451 Jessie Clark Ln, Pocatello, ID 83202-2787 | 2017-08-02 |
| 1174876205 | Bright Tomorrows Child Advocacy Center | Case Management | 409 Washington Avenue, Pocatello, ID 83201 | 2012-10-26 |
| 1821399056 | Community Mental Health Services | Case Management | 720 E Lander St, Pocatello, ID 83201-6228 | 2010-11-04 |
| 1639499684 | A Compass In Life | Case Management | 2446 Coleman St, Pocatello, ID 83201-2103 | 2010-06-01 |
| 1255656799 | Cutler Casemanagement | Case Management | 1398 Sedero Ln, Pocatello, ID 83204-7417 | 2010-03-27 |
| 1710144209 | Tri Management | Case Management | 357 W Center St Ste 201, Pocatello, ID 83204-3236 | 2008-05-21 |
| 1972771392 | Coordinated Care Services | Case Management | 250 N 5th Ave, Suite E, Pocatello, ID 83201-6278 | 2008-02-19 |
| 1528246055 | Human Dynamics and Diagnostics | Case Management | 2043 E Center St Ste 211, Pocatello, ID 83201-3300 | 2008-02-06 |
| Find all providers in POCATELLO | ||||
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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.