# AZALEA PARK MANOR LLC

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

## Provider details

- **NPI number:** 1699870329
- **Authorized official:** KRISTY DEROIN (DIRECTOR OF RCM)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 4717 W OKMULGEE ST, MUSKOGEE, OK 74401-4657
- **Practice address phone:** (918) 683-2914
- **Practice address fax:** (918) 683-3167
- **Mailing address:** 5800 W OKMULGEE ST, MUSKOGEE, OK 74401-4552
- **Mailing address phone:** (918) 683-2914
- **Mailing address fax:** (918) 683-3167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH5106-5106 | OK | Yes |

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100772250A | — | OK |