# EAST SHAWNEE NURSING CENTER L L C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRACE LIVING CENTER - EAST SHAWNEE, SEQUOYAH POINTE SKILLED NURSING AND THERAPY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619072253
- **Authorized official:** KRISTY DEROIN (DIRECTOR OF REIMBURSEMENT)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 614 E CHERRIE ST, TAHLEQUAH, OK 74464-3208
- **Practice address phone:** (918) 456-2573
- **Practice address fax:** (918) 456-6323
- **Mailing address:** 614 E CHERRIE ST, TAHLEQUAH, OK 74464-3208
- **Mailing address phone:** (918) 456-2573
- **Mailing address fax:** (918) 456-6323

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH1103-1103 | OK | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 09/30/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100772120A | — | OK |