Moonlight Mountain Recovery, Inc
LBN: Moonlight Mountain Recovery, Inc
Moonlight Mountain Recovery, Inc is an health care organization with primary practice located at 5230 W Moonlight Mine Rd , Pocatello ID 83201-9013. The organization recently has 4 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder, Residential Treatment Facilities / Substance Abuse Rehabilitation Facility. Residential Treatment Facilities / Substance Abuse Rehabilitation Facility is the primary health care specialty.
Moonlight Mountain Recovery, Inc can be contacted via phone (208) 505-9990, or through Morden, Wade via phone (208) 505-9990.
Contact Information
Primary practice address
5230 W Moonlight Mine Rd
Pocatello ID 83201-9013
Phone: (208) 505-9990
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) | 261QM0801X | ||
| Ambulatory Health Care Facilities / Adult Mental Health | 261QM0850X | ||
| Ambulatory Health Care Facilities / Rehabilitation, Substance Use Disorder | 261QR0405X | ||
| Residential Treatment Facilities / Substance Abuse Rehabilitation Facility | 324500000X | 1 | Idaho |
Profile Details
| NPI number | 1861983413 |
|---|---|
| LBN Legal business name | Moonlight Mountain Recovery, Inc |
| DBA Doing business as | |
| Authorized official | Morden, Wade |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 18th, 2018 |
| Last updated | Jan 13th, 2021 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861983413 | NPPES |
| Idaho | Other | 1 | CERTIFICATE OF APPROVAL |
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