1972643203 NPI number — ELWYN OF PENNSYLVANIA AND DELAWARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972643203 NPI number — ELWYN OF PENNSYLVANIA AND DELAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELWYN OF PENNSYLVANIA AND DELAWARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972643203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 ELWYN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELWYN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-4622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-891-7007
Provider Business Mailing Address Fax Number:
610-891-2666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 N PRESTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-895-5588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUSCH
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR. OF CONTRACT AND CREDENTIALING
Authorized Official Telephone Number:
445-206-3028

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000021240674 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240700 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240714 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240715 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240673 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240620 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240691 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240687 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000021240716 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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