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Organization
EIDETIK OF WELEETKA, LLC
Active
Organization
EIDETIK OF WELEETKA, LLC
Active
Other names
The Reach Corporation, Beverly Place
Organization subpart
No
Provider details
NPI number
Authorized official
LAILA BEAVEN (REGISTERED AGENT)
(270) 389-1919
Entity
Organization
Contact information
Practice address
1201 W TRUDGEON ST, HENRYETTA, OK 74437-4007
(918) 650-9393
(918) 650-0270
Mailing address
1201 W TRUDGEON ST, HENRYETTA, OK 74437-4007
(918) 650-9393
(918) 650-0270
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
200001110B
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200001110B
—
OK
Enumeration date
04/26/2007
Last updated
12/21/2022
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