Healthcare Provider Details

I. General information

NPI: 1306962691
Provider Name (Legal Business Name): ELWYN OF PENNSYLVANIA AND DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 SILVERSIDE RD STE 4
WILMINGTON DE
19810-3740
US

IV. Provider business mailing address

111 ELWYN RD
MEDIA PA
19063-4622
US

V. Phone/Fax

Practice location:
  • Phone: 302-300-6557
  • Fax:
Mailing address:
  • Phone: 610-497-8972
  • Fax: 610-485-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA BUSCH
Title or Position: DIR. OF CONTRACTS AND CREDENTIALING
Credential:
Phone: 445-206-3028