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General NPI Number Information
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NPI Number | 1336808872
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Entity Type | Organization
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Legal Business Name | RESTORATION HOPE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 107 ENTERPRISE PATH STE 301
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City | HIRAM
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State | GA
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Zip | 30141-2690
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Country | US
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Telephone | 770-309-9417
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Fax |
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Provider Business Mailing Address
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Address Line | 51 SAGEMONT CT
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City | ACWORTH
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State | GA
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Zip | 30101-2620
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Country | US
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Telephone | 770-309-9417
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KAITLIN HARDEN
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Credential |
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Telephone | 770-309-9417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | 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 | 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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Taxonomy #3
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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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