Healthcare Provider Details

I. General information

NPI: 1801991534
Provider Name (Legal Business Name): PUTNAM CITY CONVALESCENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 NW 32ND ST
BETHANY OK
73008-3910
US

IV. Provider business mailing address

7000 NW 32ND ST
BETHANY OK
73008-3910
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-7242
  • Fax: 405-495-7562
Mailing address:
  • Phone: 405-789-7242
  • Fax: 405-495-7562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5518-5518
License Number StateOK

VIII. Authorized Official

Name: KRISTY DEROIN
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 405-943-1144