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Eidetik Of Weleetka, Llc
Intellectual Disabilities Intermediate Care Facility in Henryetta, Oklahoma
NPI 1912127515

Eidetik Of Weleetka, Llc is a Intellectual Disabilities Intermediate Care Facility based in Henryetta, OK. Eidetik Of Weleetka, Llc practices in Henryetta, OK. The NPI Number for Eidetik Of Weleetka, Llc is 1912127515 and holds a License No. 100769440A (Oklahoma).

The current practice location address for Eidetik Of Weleetka, Llc is 1201 W Trudgeon St, Henryetta, OK and can be reached out via phone at 918-650-9393 and via fax at 918-650-0270.

Location: 1201 W Trudgeon St, Henryetta, OK, 74437
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1912127515
Provider Name
Eidetik Of Weleetka, Llc
Credential
Provider Entity Type
Organization
Address
1201 W Trudgeon St, Henryetta, OK, 74437
Phone Number
918-650-9393
Fax Number
918-650-0270
Provider Enumeration Date
04/26/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100769440A 05 OK
institution
Provider Business Practice Location Address Details
Address
1201 W Trudgeon St
City
Henryetta
State
Oklahoma
Zip
74437-4007
Phone Number
918-650-9393
Fax Number
918-650-0270
person
Provider Business Mailing Address Details
Address
1201 W Trudgeon St
City
Henryetta
State
Oklahoma
Zip
74437-4007
Phone Number
918-650-9393
Fax Number
918-650-0270
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
100769440A (Oklahoma)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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