Organization
CLINTON NURSING CENTER, LLC
Active
Other names
GRACE LIVING CENTER - CLINTON
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY DEROIN (DIRECTOR OF REIMBURSEMENT)
(405) 943-1144
Entity
Organization
Contact information
Practice address
2400 W MODELLE AVE, CLINTON, OK 73601-3724
(580) 323-1110
(580) 323-3858
Mailing address
2400 W MODELLE AVE, CLINTON, OK 73601-3724
(580) 323-1110
(580) 323-3858
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2001-2001
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100810380C
—
OK
Enumeration date
09/14/2006
Last updated
02/05/2026
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