NPIMap

Organization Active NPI

Wayne Memorial Community Health Centers

Doing business as Womens Health Center

  • Federally Qualified Health Center (FQHC)
  • Honesdale, PA
National Provider Identifier
1871739151
Registry record updated Oct 20, 2022
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
Doing business as
Womens Health Center
Practice address
626 Park St
Honesdale, PA 18431-1446
Phone
(570) 253-3005
Fax
(570) 253-0181
NPI assigned
Dec 17, 2008
Last updated
Oct 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X PA Primary

Addresses

Primary practice location

626 Park St
Honesdale, PA 18431-1446

Mailing address

601 Park St
Honesdale, PA 18431-1445
Phone (570) 253-3005

Other names 1

  • WOMENS HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090106000286 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 1871739151. Details of each certification follow.

Federally qualified health center certification: CCN 391986

Legal name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Doing business as
WOMEN'S HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 26, 2009
Last certification
Feb 26, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1983 in PA
Enrollment address
626 Park St
Honesdale, PA 18431-1446

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
39D0674518Wayne Memorial Community Health Centers626 Park Street, Honesdale, PA 18431Provider-performed microscopyAug 30, 2026

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

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 May 1, 2018
John Brennan Individual Corporate Director Sep 1, 2024
Pamela Sader Treanor Individual Corporate Director Nov 1, 2024
Michelle Louise Wonders Individual Corporate Director May 1, 2018
Steven Guccini Individual Corporate Director Jan 1, 2020
Gregory Capitolo Individual Corporate Director Feb 1, 2019
Cinda Tietjen Individual Corporate DirectorSecretary Sep 1, 2023
Robert Fortuner Individual Corporate OfficerCfo 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.

NPI Registry JSON

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1871739151",
    "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": "570-253-3005",
            "fax_number": "570-253-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311446",
            "telephone_number": "570-253-3005",
            "fax_number": "570-253-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEMORIAL COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-17",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "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": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WOMENS HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Honesdale, PA

Sources for this page

Verify at the official NPI Registry.