Eidetik of Weleetka, LLC
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Henryetta, OK
NPI 1710107313 · NPPES record last updated Dec 21, 2022
Key facts
- NPI
- 1710107313
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- 200001110B (OK)
- Legal business name
- EIDETIK OF WELEETKA, LLC
- Practice address
- 1201 W Trudgeon St
Henryetta, OK 74437-4007 - Phone
- (918) 650-9393
- Fax
- (918) 650-0270
- NPI assigned
- Apr 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Laila Beaven
- Title
- Registered Agent
- Phone
- (270) 389-1919
Corporate family (same tax ID) 18
National Provider Directory
- Tax ID family
- Eidetik of Weleetka LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 200001110B | OK | Yes |
Addresses
Primary practice location
1201 W Trudgeon St
Henryetta, OK 74437-4007
Mailing address
1201 W Trudgeon St
Henryetta, OK 74437-4007
Phone (918) 650-9393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200001110B | Medicaid | OK |
Other names
- Beverly Place
- The Reach Corporation
Other providers in Henryetta, OK
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
- Eidetik of Weleetka, LLC
All providers in Henryetta, OK · Intellectual Disabilities Intermediate Care Facility in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.