Provider Demographics
NPI:1841735149
Name:ELWYN OF PENNSYLVANIA AND DELAWARE
Entity Type:Organization
Organization Name:ELWYN OF PENNSYLVANIA AND DELAWARE
Other - Org Name:NATALE NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYER CONTRACT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:445-206-3028
Mailing Address - Street 1:111 ELWYN RD
Mailing Address - Street 2:
Mailing Address - City:ELWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4622
Mailing Address - Country:US
Mailing Address - Phone:610-891-2000
Mailing Address - Fax:
Practice Address - Street 1:1001 STERIGERE ST
Practice Address - Street 2:BLDG. 9
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-5300
Practice Address - Country:US
Practice Address - Phone:610-233-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-23
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA142770261QM0801X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021240655Medicaid