Provider Demographics
NPI:1750859732
Name:WSOP SERVICES, LLC
Entity Type:Organization
Organization Name:WSOP SERVICES, LLC
Other - Org Name:WHITESANDS OF FORT MYERS OUTPATIENT TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:HATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-373-8899
Mailing Address - Street 1:600 W HILLSBORO BLVD
Mailing Address - Street 2:STE 350
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1622
Mailing Address - Country:US
Mailing Address - Phone:786-373-8899
Mailing Address - Fax:
Practice Address - Street 1:1870 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1301
Practice Address - Country:US
Practice Address - Phone:786-373-8899
Practice Address - Fax:954-531-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder