Provider Demographics
NPI:1861090086
Name:ELDA
Entity type:Organization
Organization Name:ELDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONTA
Authorized Official - Middle Name:LARON
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:LAADAC
Authorized Official - Phone:510-759-1320
Mailing Address - Street 1:4400 GLEN CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-6458
Mailing Address - Country:US
Mailing Address - Phone:510-759-1320
Mailing Address - Fax:
Practice Address - Street 1:2334 BUCHANAN RD STE 2356
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4411
Practice Address - Country:US
Practice Address - Phone:925-436-8766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty