| Organization Name: | SOUTH PARK, INC. |
| NPI Number: | 1194930768 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RUSSELL C MCCOY (EXECUTIVE DIRECTOR) |
| Mailing Address: | 415 S Arthur Ave Pocatello |
| State: | ID US |
| Postal Code: | 832043303 |
| Phone Number: | 2082336833 |
| Fax Number: | 2082336842 |
| NPI Enumeration Date: | 05/14/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251J00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Nursing Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), by employees, contracted individuals, or via a registry, in a variety of settings. The agency may engage in providing private duty nursing and/or staffing services. |