Healthcare Provider Details

I. General information

NPI: 1639219207
Provider Name (Legal Business Name): ELWYN OF PENNSYLVANIA AND DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ELWYN RD NATALE-ADULT RTF
ELWYN PA
19063-4622
US

IV. Provider business mailing address

111 ELWYN RD
ELWYN PA
19063-4622
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-2092
  • Fax:
Mailing address:
  • Phone: 610-891-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA BUSCH
Title or Position: DIR PAYER CONTRACTING/CEDENTIALING
Credential:
Phone: 445-206-3028