NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

Doing business as Laurel Health & Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Mansfield, PA
National Provider Identifier
1609433036
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
Laurel Health & Wellness Center
Practice address
40 W Wellsboro St
Mansfield, PA 16933-1411
Phone
(570) 662-1948
NPI assigned
May 21, 2019
Last updated
Jun 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Authorized official

Name
Angela M. Vanzile
Title
Credentialing Coordinator
Phone
(570) 662-1945

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Chiropractor 111N00000X NU

Addresses

Primary practice location

40 W Wellsboro St
Mansfield, PA 16933-1411

Mailing address

40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1955

Other identifiers 1

IdentifierTypeStateIssuer
1000011720038MedicaidPA

Other names 1

  • Laurel Health & Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040416000152 PA Part B Supplier - Clinic/Group Practice 0446245880 Receives reassigned benefits from 67 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mansfield, PA; Westfield, PA; Wellsboro, PA; Troy, PA; Towanda, PA; Blossburg, PA; Elkland, PA; Lawrenceville, PA…
O20200109001460 PA Part A Provider - Federally Qualified Health Center (FQHC) 0446245880 Practice locations: Mansfield, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609433036. Details of each certification follow.

Federally qualified health center certification: CCN 391151

Legal name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
LAUREL HEALTH & WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2020
Last certification
Jan 8, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1972 in PA
Enrollment address
40 W Wellsboro St
Mansfield, PA 16933-1411

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

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
39D2170184Laurel Health Wellness Center40 West Wellsboro Street, Mansfield, PA 16933Certificate of waiverDec 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Penn Comp Health14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Scott D Myers Individual Corporate DirectorBoard Member Apr 1, 2025
John Dennis Murray Individual Corporate Director Jul 1, 2019 100%
Donna R Wilson Individual Corporate Director Jul 1, 2019 100%
Sean Sember Individual Corporate DirectorDirector Sep 22, 2021
James a Nobles Individual W-2 Managing Employee Jul 1, 2019 100%
Operational/Managerial Control Jul 1, 2019 100%
Thomas Thompson Individual Corporate OfficerTreasurer Jul 1, 2022
Jody Thomas Individual Corporate OfficerVice Chairperson Jul 1, 2019
Megan Wells-Williams Individual Corporate DirectorDirector Jul 7, 2021
Kelly Irwin Individual Corporate DirectorDirector Jul 1, 2023
Ronald M Gilbert Individual Corporate OfficerChief Financial Officer Jul 1, 2019 100%
W-2 Managing Employee Jul 1, 2019 100%
Operational/Managerial Control Jul 1, 2019 100%
Kimberly Johns Individual Corporate DirectorDirector Jun 29, 2022
Kristopher Kaufman Individual Corporate DirectorDirector Jul 1, 2022
Darla Bortz Individual Corporate DirectorBoard Member Apr 1, 2025
Jason Krise Individual Corporate OfficerChairman Jul 1, 2021

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1609433036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-21",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "VANZILE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "570-662-1945"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000011720038",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, PA

Sources for this page

Verify at the official NPI Registry.