# TIMBERLANE MANOR, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRACE LIVING CENTER - EDMOND, The Timbers Skilled Nursing and Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255425898
- **Authorized official:** KRISTY DEROIN MBA (DIRECTOR OF REIMBURSEMENT)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 2520 SOUTH RANKIN, EDMOND, OK 73013
- **Practice address phone:** (405) 341-1433
- **Practice address fax:** (405) 562-2128
- **Mailing address:** 2520 SOUTH RANKIN, EDMOND, OK 73013
- **Mailing address phone:** (405) 341-1433
- **Mailing address fax:** (405) 562-2128

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH5536-5536 | OK | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 10/14/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100810270B | — | OK |