Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
Pike County Behavioral Health and Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
750 ROUTE 739, SUITE D, LORDS VALLEY, PA 18428-6071
(570) 251-6534
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
12/12/2013
Last updated
12/12/2013
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