=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780830224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAYSIDE HOUSE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2008
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 378 NE 6TH AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-278-0055
-----------------------------------------------------
Fax | 561-276-6368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 378 NE 6TH AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-278-0055
-----------------------------------------------------
Fax | 561-276-6368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. LISA MCWHORTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-278-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 1550AD064401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1550AD064401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 1550AD064401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------