| Moonlight Mountain Recovery, Inc | |
| 5230 W Moonlight Mine Rd Pocatello ID 83201-9013 | |
| (208) 505-9990 | |
| Not Available | 
| Full Name | Moonlight Mountain Recovery, Inc | 
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility | 
| Location | 5230 W Moonlight Mine Rd, Pocatello, Idaho | 
| Authorized Official Name and Position | Wade Morden (OWNER) | 
| Authorized Official Contact | 2085059990 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Moonlight Mountain Recovery, Inc 2154 E 1340 S Heber City UT 84032-1248 Ph: () - | Moonlight Mountain Recovery, Inc 5230 W Moonlight Mine Rd Pocatello ID 83201-9013 Ph: (208) 505-9990 | 
| NPI Number | 1861983413 | 
|---|---|
| Provider Enumeration Date | 05/18/2018 | 
| Last Update Date | 01/13/2021 | 
| Certification Date | 01/13/2021 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1861983413 | NPI | - | NPPES | 
| 1 | Other | ID | CERTIFICATE OF APPROVAL | 
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