Provider Demographics
NPI:1851774665
Name:ELWYN NEW JERSEY
Entity Type:Organization
Organization Name:ELWYN NEW JERSEY
Other - Org Name:SENIOR ENRICHMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
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 1:228 W LANDIS AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8138
Mailing Address - Country:US
Mailing Address - Phone:856-794-5300
Mailing Address - Fax:
Practice Address - Street 1:1667 E LANDIS AVE STE 6
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-794-5300
Practice Address - Fax:856-794-5330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELWYN NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services