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NPI Code Detail

MEDICARE: RESTORATION HOPE WELLNESS CENTER LLC

MEDICARE: RESTORATION HOPE WELLNESS CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1336808872
Entity Type Code : Organization
Provider Name (Legal Business Name) : RESTORATION HOPE WELLNESS CENTER LLC
Provider Business Mailing Address
First Line : 51 SAGEMONT CT
Second Line :
City : ACWORTH
State : GA
Zip : 30101-2620
Country : US
Telephone Number : 770-309-9417
Fax Number :
Provider Business Practice Location Address
First Line : 107 ENTERPRISE PATH STE 301
Second Line :
City : HIRAM
State : GA
Zip : 30141-2690
Country : US
Telephone Number : 770-309-9417
Fax Number :
Authorized Official
Title or Position : CEO
Name : KAITLIN HARDEN
Credential :
Telephone Number : 770-309-9417
Provider Enumeration Date : 12/13/2021
Last Update Date : 01/08/2026

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Directions to “RESTORATION HOPE WELLNESS CENTER LLC ” Practice Location

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