Provider Demographics
NPI:1548815392
Name:ELWYN OF PENNSYLVANIA AND DELAWARE
Entity type:Organization
Organization Name:ELWYN OF PENNSYLVANIA AND DELAWARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PAYER CONTRACT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:106-639-6932
Mailing Address - Street 1:111 ELWYN RD
Mailing Address - Street 2:ZENITH CHILDREN'S RTF
Mailing Address - City:ELWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4622
Mailing Address - Country:US
Mailing Address - Phone:302-891-2000
Mailing Address - Fax:
Practice Address - Street 1:111 ELWYN RD
Practice Address - Street 2:ZENITH CHILDREN'S RTF
Practice Address - City:ELWYN
Practice Address - State:PA
Practice Address - Zip Code:19063-4622
Practice Address - Country:US
Practice Address - Phone:610-891-2342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021240229Medicaid