Healthcare Provider Details

I. General information

NPI: 1992402531
Provider Name (Legal Business Name): HOOKED ON HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 ENTERPRISE PATH STE 207
HIRAM GA
30141-2654
US

IV. Provider business mailing address

51 SAGEMONT CT
ACWORTH GA
30101-2620
US

V. Phone/Fax

Practice location:
  • Phone: 678-961-0958
  • Fax:
Mailing address:
  • Phone: 770-309-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANDREW WIDOTA
Title or Position: COO
Credential:
Phone: 609-480-9853