Healthcare Provider Details

I. General information

NPI: 1962557314
Provider Name (Legal Business Name): ELWYN OF PENNSYLVANIA AND DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ELWYN RD
ELWYN PA
19063-4622
US

IV. Provider business mailing address

111 ELWYN RD
ELWYN PA
19063-4622
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-2000
  • Fax:
Mailing address:
  • Phone: 610-891-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DONNA K BUSCH
Title or Position: PAYER CONTRACT SPECIALIST
Credential:
Phone: 610-639-6932