NPIMap

Wayne Memorial Community Health Centers

Organization Active NPI Federally Qualified Health Center (FQHC) · Lake Ariel, PA

NPI 1174974232 · NPPES record last updated Jan 16, 2025

Key facts

NPI
1174974232
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Practice address
358 Hamlin Hwy
Lake Ariel, PA 18436-9382
Phone
(570) 689-9965
NPI assigned
Jun 29, 2016
Organization subpart
No

Authorized official

Name
Teresa Lacey
Title
Chief Executive Officer
Phone
(570) 253-8451

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 47

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0909154Lake Ariel Family Health Center
358 Hamlin Highway, Lake Ariel, PA 18436		Certificate of waiverNov 26, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PA

Federally qualified health center certification: CCN 391077

Legal name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 18, 2016
Last certification
Jul 18, 2016
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jan 1, 1990 in PA
Enrollment address
358 Hamlin Hwy
Lake Ariel, PA 18436-9382

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carrie Demers
Individual 		Corporate Director Jun 1, 2015
John Brennan
Individual 		Corporate Director Sep 1, 2024
Pamela Sader Treanor
Individual 		Corporate Director Nov 28, 2024
Michelle Louise Wonders
Individual 		Corporate Director
Vice Chairman		 May 1, 2018
Steven Guccini
Individual 		Corporate Director
Treasurer		 Feb 1, 2020
Gregory Capitolo
Individual 		Corporate Director
Chairman		 Feb 1, 2019
Cinda Tietjen
Individual 		Corporate Officer
Secretary		 Dec 1, 2023
Robert Fortuner
Individual 		Corporate Director
Cfo		 Feb 1, 2015
W-2 Managing Employee
Finance Director		 Feb 1, 2015
Timothy Knapp
Individual 		Corporate Director Jan 1, 2024
Charles Curtin
Individual 		Corporate Director Jun 1, 2025
Judit Vegh
Individual 		Corporate Director Jan 1, 2024
Teresa Lacey
Individual 		Corporate Officer
Ceo		 Feb 1, 2024
W-2 Managing Employee
Ceo		 Feb 1, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20160809000378 PA Part a Provider - Federally Qualified Health Center (FQHC) 3072598937 Practice locations: Lake Ariel, PA

National Provider Directory

Tax ID family
Hamlin Family Health Center (27 organizations share this tax ID)

Locations

44 N Scott St
Carbondale, PA 18407

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

358 Hamlin Hwy
Lake Ariel, PA 18436-9382

Mailing address

601 Park St
Honesdale, PA 18431-1445
Phone (570) 253-8226

Other names

  • Lake Ariel Family Health Center Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 16, 2025.

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1174974232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311445",
            "telephone_number": "570-253-8226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 HAMLIN HWY",
            "city": "LAKE ARIEL",
            "state": "PA",
            "postal_code": "184369382",
            "telephone_number": "570-689-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEMORIAL COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "LACEY",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "570-253-8451"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Ariel Family Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Ariel, PA

All providers in Lake Ariel, PA · Federally Qualified Health Center (FQHC) in Pennsylvania

Sources for this page

Verify at the official NPI Registry.