Provider Demographics
NPI:1730542861
Name:ELWYN OF PENNSYLVAINA AND DELAWARE
Entity type:Organization
Organization Name:ELWYN OF PENNSYLVAINA AND DELAWARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR OF PAYER CONTRACTS & CREDENTIAL
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:610-891-2006
Mailing Address - Fax:
Practice Address - Street 1:419 AVENUE OF THE STATES
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4451
Practice Address - Country:US
Practice Address - Phone:610-872-4590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021240723Medicaid