Organization
REBOLD MANOR L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY DEROIN MBA (DIRECTOR OF REIMBURSEMENT)
(405) 943-1144
Entity
Organization
Contact information
Practice address
1701 E 6TH ST, OKMULGEE, OK 74447-4807
(918) 756-1967
(918) 756-4271
Mailing address
1701 E 6TH ST, OKMULGEE, OK 74447-4807
(918) 756-1967
(918) 756-4271
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH5608-5608
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200073640A
—
OK
Enumeration date
09/15/2006
Last updated
02/05/2026
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