Organization
EIDETIK OF WELEETKA
Active
Parent organization
EIDETIK OF WELEETKA, LLC
Other names
The Reach Corporation Oneida Place
Organization subpart
Yes
Provider details
NPI number
Legal business name
EIDETIK OF WELEETKA, LLC
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
P.O. BOX 525, MORGANFIELD, KY 42437
(270) 389-1919
(270) 389-1963
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
200001070A
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200001070A
—
OK
Enumeration date
04/26/2007
Last updated
02/22/2023
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