Provider Demographics
NPI:1932645108
Name:ELWYN OF PENNSYLVANIA AND DELAWARE
Entity Type:Organization
Organization Name:ELWYN OF PENNSYLVANIA AND DELAWARE
Other - Org Name:ELWYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYER CONTRACT SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
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:
Mailing Address - Fax:
Practice Address - Street 1:5218 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2347
Practice Address - Country:US
Practice Address - Phone:610-891-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021240707Medicaid