Organization
EIDETIK OF WELEEKTA, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROY BENTLEY (EXECUTIVE DIRECTOR)
(918) 650-9393
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
—
OK
Other
Enumeration date
03/22/2007
Last updated
08/22/2020
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