Provider Demographics
NPI:1891221032
Name:ELWYN NEW JERSEY
Entity type:Organization
Organization Name:ELWYN NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-794-5300
Mailing Address - Street 1:228 W LANDIS AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8138
Mailing Address - Country:US
Mailing Address - Phone:856-794-5300
Mailing Address - Fax:
Practice Address - Street 1:2564 BROOKFIELD ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7348
Practice Address - Country:US
Practice Address - Phone:856-205-9692
Practice Address - Fax:856-205-1379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELWYN NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-09
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities