NPIMap

Organization Active NPI

Moonlight Mountain Recovery, Inc

Doing business as Anxiety & Depression Centers

  • Substance Abuse Rehabilitation Facility
  • Pocatello, ID
National Provider Identifier
1861983413
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1 Issued in ID
Legal business name
MOONLIGHT MOUNTAIN RECOVERY, INC
Doing business as
Anxiety & Depression Centers
Practice address
5230 W Moonlight Mine Rd
Pocatello, ID 83201-9013
Phone
(208) 505-9990
NPI assigned
May 18, 2018
Last updated
Sep 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wade Morden
Title
Owner
Phone
(208) 505-9990

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Substance Abuse Rehabilitation Facility 324500000X 1 ID Primary
Counselor 101Y00000X

Addresses

Primary practice location

5230 W Moonlight Mine Rd
Pocatello, ID 83201-9013

Mailing address

PO Box 261
Heber City, UT 84032-0261
Phone (801) 915-8542

Other identifiers 1

IdentifierTypeStateIssuer
1OtherIDCERTIFICATE OF APPROVAL

Other names 1

  • Anxiety & Depression Centers Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2179756Moonlight Mountain Recovery Inc5230 W Moonlight Mine Rd, Pocatello, ID 83201Certificate of waiverMar 1, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1861983413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 261",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840320261",
            "telephone_number": "801-915-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5230 W MOONLIGHT MINE RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832019013",
            "telephone_number": "208-505-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLIGHT MOUNTAIN RECOVERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-18",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "MORDEN",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-505-9990"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "ID",
            "license": "1",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE OF APPROVAL",
            "identifier": "1",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anxiety & Depression Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.