Healthcare Provider Details

I. General information

NPI: 1750475547
Provider Name (Legal Business Name): ELDO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 CASTLE ST
WILMINGTON NC
28403-2103
US

IV. Provider business mailing address

1805 CASTLE ST
WILMINGTON NC
28403-2103
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-3118
  • Fax: 910-762-3115
Mailing address:
  • Phone: 910-762-3118
  • Fax: 910-762-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. YOLANDA PARKER RANDOLPH
Title or Position: DIRECTOR
Credential: M.A.
Phone: 910-452-9054