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:
Map and Directions
Authorized official contact:
Name: Morden, Wade
Phone: (208) 505-9990

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861983413 NPPES
Idaho Other 1 CERTIFICATE OF APPROVAL

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