Healthcare Provider Details

I. General information

NPI: 1750859732
Provider Name (Legal Business Name): WSOP SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 COLONIAL BLVD
FORT MYERS FL
33907-1301
US

IV. Provider business mailing address

600 W HILLSBORO BLVD STE 350
DEERFIELD BEACH FL
33441-1622
US

V. Phone/Fax

Practice location:
  • Phone: 786-373-8899
  • Fax: 954-531-1827
Mailing address:
  • Phone: 786-373-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID L HATTON
Title or Position: GENERAL COUNSEL / MANAGER
Credential:
Phone: 786-373-8899