NPIMap

Organization Active NPI

Children's Service Center of Wyoming Valley Inc

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
National Provider Identifier
1689527392
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC
Practice address
21 Academy St
Wilkes Barre, PA 18702-3801
Phone
(570) 825-6425
Fax
(570) 762-9013
NPI assigned
Feb 20, 2026
Last updated
Aug 12, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

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

Authorized official

Name
Sharon Vivian
Title
Cfo
Phone
(570) 825-6425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

21 Academy St
Wilkes Barre, PA 18702-3801

Mailing address

335 S Franklin St
Wilkes Barre, PA 18702-3808
Phone (570) 825-6425

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260319000499 PA Part A Provider - Federally Qualified Health Center (FQHC) 1052567617 Practice locations: Wilkes Barre, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689527392. Details of each certification follow.

Federally qualified health center certification: CCN D31062

Legal name
CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 13, 2026
Last certification
Mar 13, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
21 Academy St
Wilkes Barre, PA 18702-3801

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Children's Service Center of Wyoming Valley13 organizations share this tax ID, including this one
Part of
Children's Service Center of Wyoming Valley

Other organizations with this tax ID 12

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

Locations

21 Academy St
Wilkes Barre, PA 18702
Phone (570) 301-0935

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Joel Smith Individual W-2 Managing EmployeeCio Apr 9, 2017
Colleen Doyle Individual Corporate OfficerPresident Dec 4, 2023
Edward Coleman Individual Corporate OfficerVice President Nov 1, 2025
Matthew Shaffer Individual Corporate OfficerTreasurer Nov 25, 2024
John Henry Individual Corporate OfficerSecretary Nov 25, 2024
Sharon Kaye Pisarcik Individual W-2 Managing EmployeeCfo Jan 1, 2017
Christopher Boyle Individual W-2 Managing EmployeeCeo May 12, 2008

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Children's Service Center of Wyoming Valley IncWilkes Barre, PA, CCN D31039 Federally qualified health center Operational/Managerial Control Jul 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1771545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786492800000",
    "number": "1689527392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 S FRANKLIN ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023808",
            "telephone_number": "570-825-6425",
            "fax_number": "570-762-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 ACADEMY ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023801",
            "telephone_number": "570-825-6425",
            "fax_number": "570-762-9013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S SERVICE CENTER OF WYOMING VALLEY INC",
        "enumeration_date": "2026-02-20",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A",
        "authorized_official_last_name": "VIVIAN",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-825-6425"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.