Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Eidetik of Weleetka, LLC

Organization Intellectual Disabilities Intermediate Care Facility · NPI 1629298229

Eidetik of Weleetka, LLC is an Intellectual Disabilities Intermediate Care Facility in Henryetta, Oklahoma. Licensed in Oklahoma. Registered with an NPI since 2007.

Licensed in
OK
In the registry since
2007
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1201 W Trudgeon St
Henryetta, OK 74437-4007
Phone: (918) 650-9393
Fax: (918) 650-0270
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual Disabilities Intermediate Care Facility (primary) Taxonomy 315P00000X · Licence 200002020A (OK)

Record details

NPI number1629298229
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationEidetik of Weleetka, LLC
Authorized official Laila Beaven — Registered Agent · (270) 389-1919
Other names Lake Place; The Reach Corporation-Name To Be Changed To
NPI enumeratedApril 26, 2007
Last updated in NPPESDecember 23, 2022
Certification dateDecember 23, 2022
Mailing address1201 W. Trudgeon St., Henryetta, OK 74437

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