# CLINTON NURSING CENTER, LLC

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

## Provider details

- **NPI number:** 1568567113
- **Authorized official:** KRISTY DEROIN (DIRECTOR OF REIMBURSEMENT)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 2400 W MODELLE AVE, CLINTON, OK 73601-3724
- **Practice address phone:** (580) 323-1110
- **Practice address fax:** (580) 323-3858
- **Mailing address:** 2400 W MODELLE AVE, CLINTON, OK 73601-3724
- **Mailing address phone:** (580) 323-1110
- **Mailing address fax:** (580) 323-3858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2001-2001 | OK | Yes |

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100810380C | — | OK |