Organization
SOONER GERIATRICS, LLC
Active
Other names
WILDEWOOD SKILLED NURSING AND THERAPY, Sooner Geriatrics, LLC, GRACE LIVING CENTER - WILDEWOOD
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY DEROIN (DIRECTOR OF REIMBURSEMENT)
(405) 943-1144
Entity
Organization
Contact information
Practice address
1913 NE 50TH ST, OKLAHOMA CITY, OK 73111-7003
(405) 427-5414
(405) 427-5432
Mailing address
1921 NE 50TH ST, OKLAHOMA CITY, OK 73111-2420
(405) 427-5414
(405) 427-5432
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH5501-5501
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100778040A
—
OK
Enumeration date
09/14/2006
Last updated
02/06/2026
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