NPIMap

Organization Active NPI

Wayne Memorial Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Lake Ariel, PA
National Provider Identifier
1174974232
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jan 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 2

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

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 1

  • Lake Ariel Family Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174974232. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 1, 1990 in PA
Enrollment address
358 Hamlin Hwy
Lake Ariel, PA 18436-9382

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0909154Lake Ariel Family Health Center358 Hamlin Highway, Lake Ariel, PA 18436Certificate of waiverNov 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hamlin Family Health Center27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

44 N Scott St
Carbondale, PA 18407

Ownership & related parties

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 DirectorVice Chairman May 1, 2018
Steven Guccini Individual Corporate DirectorTreasurer Feb 1, 2020
Gregory Capitolo Individual Corporate DirectorChairman Feb 1, 2019
Cinda Tietjen Individual Corporate OfficerSecretary Dec 1, 2023
Robert Fortuner Individual Corporate DirectorCfo Feb 1, 2015
W-2 Managing EmployeeFinance 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 OfficerCeo Feb 1, 2024
W-2 Managing EmployeeCeo Feb 1, 2024

Owners & managing parties with NPI records 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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

Sources for this page

Verify at the official NPI Registry.