Provider Demographics
NPI:1871014092
Name:WAYNE COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:WAYNE COMMUNITY HEALTH CENTERS, INC
Other - Org Name:ESCALANTE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-425-1102
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:UT
Mailing Address - Zip Code:84715-0303
Mailing Address - Country:US
Mailing Address - Phone:435-425-3744
Mailing Address - Fax:435-425-1138
Practice Address - Street 1:65 NORTH CENTER STREET
Practice Address - Street 2:
Practice Address - City:ESCALANTE
Practice Address - State:UT
Practice Address - Zip Code:84776-0276
Practice Address - Country:US
Practice Address - Phone:435-826-4333
Practice Address - Fax:435-826-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261QD0000X, 261QF0400X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty