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NPI Code Detail

MEDICARE: ELWYN OF PENNSYLVANIA AND DELAWARE

MEDICARE: ELWYN OF PENNSYLVANIA AND DELAWARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
4251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215548615
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELWYN OF PENNSYLVANIA AND DELAWARE
Provider Business Mailing Address
First Line : 111 ELWYN RD
Second Line :
City : MEDIA
State : PA
Zip : 19063-4622
Country : US
Telephone Number : 610-891-7007
Fax Number : 610-891-2666
Provider Business Practice Location Address
First Line : 111 ELWYN RD
Second Line :
City : MEDIA
State : PA
Zip : 19063-4622
Country : US
Telephone Number : 610-891-7007
Fax Number : 610-891-2666
Authorized Official
Title or Position : PAYER CONTRACT SPECIALIST
Name : DONNA K BUSCH
Credential :
Telephone Number : 445-206-3028
Provider Enumeration Date : 08/11/2020
Last Update Date : 09/17/2025

Similar Medicare Providers

1538003801 — NICOLE THORP MSW, LCSW
Practice Location Address:
111 ELWYN RD
MEDIA, PA
19063-4622
Practice Phone: 610-891-2000
Practice Fax:
1821166711 — DR. STEVEN G KLOTZ MD
Practice Location Address:
111 ELWYN RD
MEDIA, PA
19063-4622
Practice Phone: 610-415-9301
Practice Fax: 610-415-1656
1588907125 — LAUREN ELIZABETH MOORE MD
Practice Location Address:
111 ELWYN RD
MEDIA, PA
19063-4622
Practice Phone: 610-891-2324
Practice Fax:
1033546171 — MS. KIA MICHELE HUNTER M. S.
Practice Location Address:
111 ELWYN RD
MEDIA, PA
19063-4622
Practice Phone: 267-666-7474
Practice Fax:
1285176818 — MS. JANE GRIVAS M.ED. DIP.ED.LBS
Practice Location Address:
111 ELWYN RD
MEDIA, PA
19063-4622
Practice Phone: 610-891-7007
Practice Fax: 610-891-2666
1013422526 — ELWYN OF PENNSYLVANIA AND DELAWARE
Practice Location Address:
111 ELWYN RD
MEDIA, PA
19063-4622
Practice Phone: 610-891-7317
Practice Fax:

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