| Elwyn | |
|
4017 Ludlow St Philadelphia PA 19104-3085 | |
| (610) 891-2092 | |
| Not Available |
| Full Name | Elwyn |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4017 Ludlow St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Donna K Busch (PAYER CONTRACT SPECIALIST) |
| Authorized Official Contact | 4452063028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elwyn 111 Elwyn Road New Vision Psychiatric Rehab Elwyn PA 19063 Ph: (610) 891-2006 | Elwyn 4017 Ludlow St Philadelphia PA 19104-3085 Ph: (610) 891-2092 |
| NPI Number | 1164681821 |
|---|---|
| Provider Enumeration Date | 06/06/2008 |
| Last Update Date | 07/20/2022 |
| Certification Date | 07/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164681821 | NPI | - | NPPES |
| 1000021240389 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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