NPI age
8 years
Enumerated 2018-05-18
● Active Type 2 · Organization
Moonlight Mountain Recovery, Inc
Moonlight Mountain Recovery, Inc is 1 of 36 substance abuse rehabilitation facility organizations in Idaho.
Primary specialty
Substance Abuse Rehabilitation Facility
Plus 3 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Morden
Owner
Last NPPES update
2021-01-13
Source: monthly bulk 2026-05
How this organization compares
Across 36 active substance abuse rehabilitation facility providers in Idaho.
NPI age
8 years
≈ at median (8 yr)
Practice locations
1
0 secondary on file
Subspecialties
3
In the 33% of peers with subspecialties
NPI lifetime · 2018 → 2026
2018-05Enumerated in NPPES
2018
2026
Where they practice
Primary practice location
5230 W Moonlight Mine Rd
Pocatello, ID 832019013
Mailing address
2154 E 1340 S
Heber City, UT 840321248
Authorized official
Wade Morden
Owner
📞 2085059990
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Emily Flint, LPC Counselor NPI 1831873975
- Zachary Kinney, RECOVERY COACH Peer Specialist NPI 1619694312
Specialties
-
Substance Abuse Rehabilitation Facility PrimaryA 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.
-
Clinic/CenterDefinition to come...
-
Clinic/CenterAn entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
-
Clinic/CenterDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1 | CERTIFICATE OF APPROVAL |
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
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