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General NPI Number Information
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NPI Number | 1811760275
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Entity Type | Organization
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Legal Business Name | MOUNTAIN HEALTH SYSTEMS
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 3303 ASPEN RIDGE CIR
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City | KIMBERLY
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State | ID
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Zip | 83341-5511
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Country | US
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Telephone | 208-420-8752
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Fax |
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Provider Business Mailing Address
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Address Line | 3303 ASPEN RIDGE CIR
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City | KIMBERLY
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State | ID
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Zip | 83341-5511
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Country | US
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Telephone | 208-420-8752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY MARC POTTER
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Credential |
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Telephone | 208-420-8752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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