Elwyn of Pennsylvania and Delaware

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

ELWYN OF PENNSYLVANIA AND DELAWARE

Practice address

3 Irving Rd
Wallingford, PA 19086-6626

Phone

(610) 891-2000

NPI assigned

Mar 12, 2007

Last updated

Feb 10, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donna K Busch

Title

Dir Payer Contract & Credentialing

Phone

(445) 206-3028

Specialties & licenses 1

Addresses

Other names 1

• Elwyn of Pennsylvania and Delaware Nether Providence Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659403723. Details of each certification follow.

• CCN 39G221 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 39G221

Legal name

ELWYN OF PENNSYLVANIA AND DELAWARE - NETHER PROVID

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jan 25, 1990

Last certification

Jul 9, 2025

Beds

6

Ownership / control type

Private (non-profit)

Facility address

3 Irving Rd
Wallingford, PA 19086

Tax ID family

Elwyn Aston61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Elwyn

  • Early Intervention Provider Agency
  • Philadelphia, PA
  • NPI 1396995411
  NPD tax ID
• Elwyn

  • Community/Behavioral Health Agency
  • Elwyn, PA
  • NPI 1417345455
  NPD tax ID
• Elwyn

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Glenolden, PA
  • NPI 1457485955
  NPD tax ID
• Elwyn

  • Case Management Agency
  • Elwyn, PA
  • NPI 1528108875
  NPD tax ID
• Elwyn

  • Local Education Agency (LEA)
  • Elwyn, PA
  • NPI 1568501799
  NPD tax ID
• Elwyn

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Elwyn, PA
  • NPI 1568502607
  NPD tax ID
• Elwyn

  • Case Management Agency
  • Elwyn, PA
  • NPI 1619017969
  NPD tax ID
• Elwyn

  • Clinic/Center
  • Elwyn, PA
  • NPI 1669637898
  NPD tax ID
• Elwyn

  • Community/Behavioral Health Agency
  • Elwyn, PA
  • NPI 1689870545
  NPD tax ID
• Elwyn

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Elwyn, PA
  • NPI 1700926847
  NPD tax ID
• Elwyn

  • Community/Behavioral Health Agency
  • Elwyn, PA
  • NPI 1720128390
  NPD tax ID
• Elwyn

  • Community/Behavioral Health Agency
  • Elwyn, PA
  • NPI 1760522007
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1659403723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 ELWYN RD",
            "address_2": "CRS",
            "city": "ELWYN",
            "state": "PA",
            "postal_code": "190634622",
            "telephone_number": "610-891-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 IRVING RD",
            "city": "WALLINGFORD",
            "state": "PA",
            "postal_code": "190866626",
            "telephone_number": "610-891-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELWYN OF PENNSYLVANIA AND DELAWARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "BUSCH",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIR PAYER CONTRACT & CREDENTIALING",
        "authorized_official_telephone_number": "445-206-3028"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elwyn of Pennsylvania and Delaware Nether Providence",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Rajeshkumar R Desai, OTR/L
• Barbara Didenko, LPT-PHYSICAL THERAPI
• Dr. O. Family Chiropractic
• Linda Jean Echols, PHD, MBA, CRNP
• June E. Elcock-Messam, M.D.
• Katelyn Eng, OTR/L
• Lise Fishman
• Sara Virginia Fortunato, PTA, CLT, LMT
• Priscilla Ann Fortune-Bell
• Wayne Gabe

• Intellectual Disabilities Intermediate Care Facility in Wallingford, PA
• Providers in Wallingford, PA by specialty
• Intellectual Disabilities Intermediate Care Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.