Malvern Constitution LLC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

MALVERN CONSTITUTION LLC

Practice address

1930 S Broad St
Philadelphia, PA 19145-2328

Phone

(610) 941-3390

NPI assigned

Jul 11, 2019

Organization subpart

No

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

Authorized official

Name

Glenn Gabris

Title

Chief Financial Officer

Phone

(610) 941-3390

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Hospital certification: CCN 394057

Legal name

MALVERN CONSTITUTION LLC

Doing business as

MALVERN BEHAVIORAL HEALTH

Certification status

Active

Provider type (POS)

Hospital – Psychiatric

Participating since

Sep 18, 2020

Last certification

Sep 18, 2020

Beds

22

Ownership / control type

Other

Organization structure

LLCProprietary

Enrollment address

1930 S Broad St
Philadelphia, PA 19145-2328
Main/Primary Hospital Location

Hospital subgroups

Psychiatric

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Malvern Constitution LLC

  dba Malvern Behavioral Health

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1952268195

  0648606681

  Same PAC ID

Listed as

Malvern Behavioral HealthCCN 394057 · All quality measures

Type

Psychiatric

Ownership

Voluntary non-profit - Other

Medicare certification status

ActiveFrom the Provider of Services file

Emergency services

No

Tax ID family

Malvern Constitution LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Malvern Constitution LLC

  dba Malvern Behavioral Health

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1952268195
  NPD tax ID

Locations

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Fox Subacute at South Philadelphia LLC

  • Skilled Nursing Facility
  • Philadelphia, PA
  • NPI 1821444209

  Operational/Managerial Control

  CMS ownership

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cyntrell Crawford, M.D.

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1710242904
  NPD (past)
• Syed T. Ibrahim, MD

  • Psychiatry Physician
  • Pottsville, PA
  • NPI 1447346127
  NPD (past)
• Radhika Rani, DO

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1588234975
  NPD (past)
• Jeffrey Hayden Simon, M.D.

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1861651077
  NPD (past)

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762128000000",
    "number": "1700438660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 E. TOWNSHIP LINE ROAD, SUITE 115",
            "address_2": "TWO VALLEY SQUARE",
            "city": "BLUE BELL",
            "state": "PA",
            "postal_code": "19422",
            "telephone_number": "610-941-3390",
            "fax_number": "610-941-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452328",
            "telephone_number": "610-941-3390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3905 Ford Rd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191312824",
            "country_code": "US",
            "telephone_number": "610-480-8919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MALVERN CONSTITUTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-11",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A",
        "authorized_official_last_name": "GABRIS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "610-941-3390"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Lindhardt Malphrus
• Jonathan Maltzman, MD
• Julie Maltzman, M.D.
• Jonathan Andrew Malucci, D.C.
• Yael Malul, CRNP
• Malvern Constitution LLC (Malvern Behavioral Health)
• Priya Mamachan, DMD
• Algird R Mameniskis, M.D., F.A.C.S.
• Mamesee Home Health Care LLC
• Sanjana Reddy Mamidi, DDS

• Psychiatric Hospital in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatric Hospital in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.