MEDICARE: RESTAURA BEHAVIORAL HEALTH

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
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1487491270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTAURA BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2450 LAWRENCEVILLE HWY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3268
Country	:	US
Telephone Number	:	404-310-8090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 LAWRENCEVILLE HWY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3268
Country	:	US
Telephone Number	:	404-310-8090
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NICOLE LIEBB
Credential	:
Telephone Number	:	732-522-4338

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	04/15/2026

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Directions to “RESTAURA BEHAVIORAL HEALTH ” Practice Location

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