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General NPI Number Information
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NPI Number | 1548815392
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Entity Type | Organization
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Legal Business Name | ELWYN OF PENNSYLVANIA AND DELAWARE
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 111 ELWYN RD ZENITH CHILDREN'S RTF
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City | ELWYN
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State | PA
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Zip | 19063-4622
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Country | US
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Telephone | 610-891-2342
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Fax |
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Provider Business Mailing Address
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Address Line | 111 ELWYN RD ZENITH CHILDREN'S RTF
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City | ELWYN
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State | PA
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Zip | 19063-4622
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Country | US
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Telephone | 302-891-2000
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Fax |
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Authorized Official
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Title or Position | PAYER CONTRACT SPECIALIST
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Name | DONNA BUSCH
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Credential |
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Telephone | 106-639-6932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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