EIDETIK OF WELEETKA LLC NPI 1245450840

NPI Information

NPI: 1245450840
Provider Name: EIDETIK OF WELEETKA, LLC

Doing Business As: TAFT PLACE

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
1201 W TRUDGEON ST
HENRYETTA, OK
ZIP 74437
Phone: (918) 650-9393
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EIDETIK OF WELEETKA, LLC is an intermediate care facility mentally retarded in Henryetta, OK. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. EIDETIK OF WELEETKA, LLC NPI is 1245450840. The provider is registered as an organization entity type.
The provider Is Doing Business As Taft Place.

The provider's business location address is:

1201 W TRUDGEON ST
HENRYETTA, OK
ZIP 74437-007
Phone: (918) 650-9393
Fax: (918) 650-0270

The provider's authorized official is Laila Beaven .
The authorized official title is Registered Agent and has the following contact phone number (270) 389-1919.

The enumeration date for this NPI number is 4/26/2007 and was last updated on 12/23/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		200001110G	OKLAHOMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200001110G	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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