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Organization
UNIVERSITY NORTHWEST, LLC
Active
Organization
UNIVERSITY NORTHWEST, LLC
Active
Other names
GRACE LIVING CENTER - UNIVERSITY NW, UNIVERSITY PARK MEMORY CARE SKILLED NURSING AND THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY DEROIN (DIRECTOR OF REIMBURSEMENT)
(405) 943-1144
Entity
Organization
Contact information
Practice address
1201 N VINITA AVE, TAHLEQUAH, OK 74464-6429
(918) 456-6181
(918) 456-1512
Mailing address
1201 N VINITA AVE, TAHLEQUAH, OK 74464-6429
(918) 456-6181
(918) 456-1512
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH1101-1101
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100776450A
—
OK
Enumeration date
09/14/2006
Last updated
02/05/2026
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