Organization · Type 2 NPI

Eidetik of Weleetka, LLC

Intellectual Disabilities Intermediate Care Facility · Henryetta, OK

NPI number 1518187111 Active

Practice location

1201 W Trudgeon St
Henryetta, OK 74437-4007

Call (918) 650-9393 Map

Fax (918) 650-0270

Mailing address

1201 W. Trudgeon St.
Henryetta, OK 74437-4007

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	200001110D (OK)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

17 other providers at this address

Other intellectual disabilities intermediate care facility providers in Henryetta

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NPI record

NPI: 1518187111
Entity type: Organization (Type 2)
Issued: Apr 26, 2007
Last updated: Dec 23, 2022
Status: Active
Subpart: Yes of Eidetik of Weleetka, LLC

Other names

<unavail>
Liberty Place · doing business as
The Reach Corporation · other name

Authorized official

Laila Beaven
Registered Agent
(270) 389-1919

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1518187111

Eidetik of Weleetka, LLC's National Provider Identifier is 1518187111, issued on Apr 26, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Henryetta, OK. The record was last updated on Dec 23, 2022.