NPIMap

Organization Active NPI

Eidetik of Weleetka

Doing business as The Reach Corporation Oneida Place

  • Intellectual Disabilities Intermediate Care Facility
  • Henryetta, OK
National Provider Identifier
1992925598
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
200001070A Issued in OK
Legal business name
EIDETIK OF WELEETKA
Doing business as
The Reach Corporation Oneida Place
Practice address
1201 W Trudgeon St
Henryetta, OK 74437-4007
Phone
(918) 650-9393
Fax
(918) 650-0270
NPI assigned
Apr 26, 2007
Last updated
Feb 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
EIDETIK OF WELEETKA, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laila Beaven
Title
Registered Agent
Phone
(270) 389-1919

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 200001070A OK Primary

Addresses

Primary practice location

1201 W Trudgeon St
Henryetta, OK 74437-4007

Mailing address

P.O. Box 525
Morganfield, KY 42437
Phone (270) 389-1919

Other identifiers 1

IdentifierTypeStateIssuer
200001070AMedicaidOK

Other names 1

  • The Reach Corporation Oneida Place Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eidetik of Weleetka19 organizations share this tax ID, including this one
Part of
Eidetik of Weleetka

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1992925598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 525",
            "city": "MORGANFIELD",
            "state": "KY",
            "postal_code": "42437",
            "telephone_number": "270-389-1919",
            "fax_number": "270-389-1963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W TRUDGEON ST",
            "city": "HENRYETTA",
            "state": "OK",
            "postal_code": "744374007",
            "telephone_number": "918-650-9393",
            "fax_number": "918-650-0270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EIDETIK OF WELEETKA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EIDETIK OF WELEETKA, LLC",
        "enumeration_date": "2007-04-26",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "BEAVEN",
        "authorized_official_first_name": "LAILA",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "270-389-1919"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OK",
            "license": "200001070A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200001070A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Reach Corporation Oneida Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henryetta, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.