NPIMap

Organization Active NPI

Wayne Memorial Community Health Centers

Doing business as Together For Health Dental Center

  • General Practice Dentistry
  • Honesdale, PA
National Provider Identifier
1740490473
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Doing business as
Together For Health Dental Center
Practice address
601 Park St
Honesdale, PA 18431-1445
Phone
(570) 251-6641
NPI assigned
May 23, 2007
Last updated
Jan 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

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

Authorized official

Name
Frederick Jackson
Title
Executive Director
Phone
(570) 253-8450

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

601 Park St
Honesdale, PA 18431-1445

Mailing address

600 Maple Ave Ste 7
Honesdale, PA 18431-1459

Other identifiers 2

IdentifierTypeStateIssuer
1007765560002MedicaidPA
986352OtherPABS DENTAL PROVIDER NUMBER

Other names 1

  • Together For Health Dental Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260423002114 PA Part A Provider - Federally Qualified Health Center (FQHC) 3072598937 Practice locations: Honesdale, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740490473. Details of each certification follow.

Federally qualified health center certification: CCN D31061

Legal name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Doing business as
TOGETHER FOR HEALTH DENTAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 18, 2026
Last certification
Mar 18, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
600 Maple Ave
Ste 7
Honesdale, PA 18431-1459

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

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

600 Maple Ave
Ste 7
Honesdale, PA 18431
Phone (570) 251-6534

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 1, 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 DirectorSecretary Dec 1, 2023
Robert Fortuner Individual Corporate Director Feb 1, 2015
W-2 Managing EmployeeCfo 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.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1740490473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 MAPLE AVE STE 7",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311445",
            "telephone_number": "570-251-6641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEMORIAL COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "570-253-8450"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007765560002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS DENTAL PROVIDER NUMBER",
            "identifier": "986352",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Together For Health Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Honesdale, PA

Sources for this page

Verify at the official NPI Registry.