Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Moonlight Mountain Recovery, Inc

Organization Mental Health Clinic/Center (Including Community Mental Health Center) · NPI 1861983413

Moonlight Mountain Recovery, Inc is a Mental Health Clinic/Center (Including Community Mental Health Center) in Pocatello, Idaho. Licensed in Idaho. Registered with an NPI since 2018.

Licensed in
ID
In the registry since
2018
Specialties on file
4
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5230 W Moonlight Mine Rd
Pocatello, ID 83201-9013
Phone: (208) 505-9990
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Substance Abuse Rehabilitation Facility (primary) Taxonomy 324500000X · Licence 1 (ID)
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X
Adult Mental Health Clinic/Center Taxonomy 261QM0850X
Substance Use Disorder Rehabilitation Clinic/Center Taxonomy 261QR0405X

Record details

NPI number1861983413
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Wade Morden — Owner · (208) 505-9990
NPI enumeratedMay 18, 2018
Last updated in NPPESJanuary 13, 2021
Certification dateJanuary 13, 2021
Mailing address2154 E 1340 S, Heber City, UT 84032-1248

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