NPI 1003036609

Eidetik of Weleetka, LLC

Organisation Intellectual Disabilities Intermediate Care Facility Henryetta, OK

Practice location

Address: 1201 W Trudgeon St, Henryetta, OK 74437-4007
Phone: (918) 650-9393
Fax: (918) 650-0270

Authorised official

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

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 100770750A (OK)

Other Intermediate Care Facility, Intellectual Disabilities providers in Oklahoma →

Registry record

NPI: 1003036609
Entity type: Organization
NPI issued: 26 Apr 2007
Record last updated: 21 Dec 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.