# NORTHWEST INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRACE LIVING CENTER - NORTHWEST OKC, Fairmont Skilled Nursing and Therapy, Northwest Incorporated, Fairmont
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528163391
- **Authorized official:** KRISTY DEROIN (DIRECTOR OF RCM)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 3233 NW 10TH ST, OKLAHOMA CITY, OK 73107-5203
- **Practice address phone:** (405) 943-8366
- **Practice address fax:** (405) 488-0100
- **Mailing address:** 3233 NW 10TH ST, OKLAHOMA CITY, OK 73107-5203
- **Mailing address phone:** (405) 943-8366
- **Mailing address fax:** (405) 488-0100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH5511-5511 | OK | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 02/05/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100771780A | — | OK |