Provider Demographics
NPI:1669037636
Name:ELWYN NEW JERSEY
Entity Type:Organization
Organization Name:ELWYN NEW JERSEY
Other - Org Name:ELWYN NJ SESG
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-794-5300
Mailing Address - Street 1:ELWYN NEW JERSEY
Mailing Address - Street 2:208 W. LANDIS AVENUE
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-794-5300
Mailing Address - Fax:
Practice Address - Street 1:ELWYN NEW JERSEY SUPPORTED EMPLOYMENT SMALL GROUP
Practice Address - Street 2:228 W. LANDIS AVENUE, SUITE 302
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-794-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELWYN NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-06
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services