Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
Honesdale Behavorial Health
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
600 MAPLE AVE STE 15, HONESDALE, PA 18431-1460
(570) 253-8219
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/28/2017
Last updated
09/14/2020
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