Provider Demographics
NPI:1073609954
Name:ELDO, INC.
Entity Type:Organization
Organization Name:ELDO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:910-762-3118
Mailing Address - Street 1:1805 CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2103
Mailing Address - Country:US
Mailing Address - Phone:910-762-3118
Mailing Address - Fax:910-762-3115
Practice Address - Street 1:1805 CASTLE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2103
Practice Address - Country:US
Practice Address - Phone:910-762-3118
Practice Address - Fax:910-762-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409558Medicaid