# SOONER GERIATRICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WILDEWOOD SKILLED NURSING AND THERAPY, Sooner Geriatrics, LLC, GRACE LIVING CENTER - WILDEWOOD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164527727
- **Authorized official:** KRISTY DEROIN (DIRECTOR OF REIMBURSEMENT)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 1913 NE 50TH ST, OKLAHOMA CITY, OK 73111-7003
- **Practice address phone:** (405) 427-5414
- **Practice address fax:** (405) 427-5432
- **Mailing address:** 1921 NE 50TH ST, OKLAHOMA CITY, OK 73111-2420
- **Mailing address phone:** (405) 427-5414
- **Mailing address fax:** (405) 427-5432

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH5501-5501 | OK | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 02/06/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100778040A | — | OK |