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Moonlight Mountain Recovery, Inc
Substance Abuse Rehabilitation Facility in Pocatello, Idaho
NPI 1861983413

Moonlight Mountain Recovery, Inc is a Substance Abuse Rehabilitation Facility based in Heber City, ID. Moonlight Mountain Recovery, Inc practices in Pocatello, ID. The NPI Number for Moonlight Mountain Recovery, Inc is 1861983413 and holds a License No. (Idaho).

The current practice location address for Moonlight Mountain Recovery, Inc is 5230 W Moonlight Mine Rd, Pocatello, ID and can be reached out via phone at 208-505-9990.

Location: 5230 W Moonlight Mine Rd, Pocatello, ID, 84032-1248
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1861983413
Provider Name
Moonlight Mountain Recovery, Inc
Credential
Provider Entity Type
Organization
Address
5230 W Moonlight Mine Rd, Pocatello, ID, 84032-1248
Phone Number
208-505-9990
Fax Number
Provider Enumeration Date
05/18/2018
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1 01 ID CERTIFICATE OF APPROVAL
institution
Provider Business Practice Location Address Details
Address
5230 W Moonlight Mine Rd
City
Pocatello
State
Idaho
Zip
83201-9013
Phone Number
208-505-9990
Fax Number
person
Provider Business Mailing Address Details
Address
5230 W Moonlight Mine Rd
City
Pocatello
State
Idaho
Zip
83201-9013
Phone Number
208-505-9990
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
1 (Idaho)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adult Mental Health
Taxonomy
261QM0850X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Rehabilitation, Substance Use Disorder
Taxonomy
261QR0405X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Residential Treatment Facilities
Classification
Substance Abuse Rehabilitation Facility
Speciality
-
Taxonomy
324500000X
License No.
()
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
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