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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.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Substance Abuse Disorder Rehabilitation Facility |
324500000X | |||
Adult Mental Health |
261QM0850X | |||
Mental Health (Including Community Mental Health Center) |
261QM0801X | B4[14] | Community Mental Health Center | |
Rehabilitation, Substance Use Disorder |
261QR0405X |
| NPI # | 1861983413 |
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| LBN Legal business name | MOONLIGHT MOUNTAIN RECOVERY, INC | ||||||||
| Authorized official | WADE MORDEN - (OWNER) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/18/2018 | ||||||||
| Last updated | 01/13/2021 - About 5 years ago | ||||||||
| Identifiers |
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MOONLIGHT MOUNTAIN RECOVERY, INC