# WYNNEWOOD NURSING CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRACE LIVING CENTER - WYNNEWOOD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063517704
- **Authorized official:** MIKE DIMOND (MANAGER)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 810 E CALIFORNIA ST, WYNNEWOOD, OK 73098-3207
- **Practice address phone:** (405) 665-2330
- **Practice address fax:** (405) 665-4378
- **Mailing address:** 810 E CALIFORNIA ST, WYNNEWOOD, OK 73098-3207
- **Mailing address phone:** (405) 665-2330
- **Mailing address fax:** (405) 665-4378

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2506-2506 | OK | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 08/22/2020