Organization
RESTORATION OUTPATIENT DETOX WOODSTOCK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW WIDOTA (COO)
(609) 480-9853
Entity
Organization
Contact information
Practice address
355 PARKWAY 575 STE 200-B, WOODSTOCK, GA 30188-4872
(609) 480-9853
Mailing address
51 SAGEMONT CT, ACWORTH, GA 30101-2620
(770) 309-9417
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/25/2025
Last updated
01/08/2026
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