Organization
MOUNTAIN HEALTH SYSTEMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY MARC POTTER (OWNER)
(208) 420-8752
Entity
Organization
Contact information
Practice address
3303 ASPEN RIDGE CIR, KIMBERLY, ID 83341-5511
(208) 420-8752
Mailing address
3303 ASPEN RIDGE CIR, KIMBERLY, ID 83341-5511
(208) 420-8752
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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