NPI 1861983413

Moonlight Mountain Recovery, INC

Organisation Substance Abuse Rehabilitation Facility Pocatello, ID

Practice location

Address: 5230 W Moonlight Mine Rd, Pocatello, ID 83201-9013
Phone: (208) 505-9990
Mailing address: 2154 E 1340 S, Heber City, UT 84032-1248

Authorised official

Name: Wade Morden
Title: Owner
Phone: (208) 505-9990

Registered specialties (4)

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 1 (ID)

Other Substance Abuse Rehabilitation Facility providers in Idaho →

Mental Health Clinic/Center (Including Community Mental Health Center)

Ambulatory Health Care Facilities Taxonomy 261QM0801X

Other Clinic/Center providers in Idaho →

Adult Mental Health Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QM0850X

Substance Use Disorder Rehabilitation Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QR0405X

Registry record

NPI: 1861983413
Entity type: Organization
NPI issued: 18 May 2018
Record last updated: 13 Jan 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.