Healthcare Provider Details

I. General information

NPI: 1538661905
Provider Name (Legal Business Name): SENIOR VILLAGE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N MADISON AVE
BLANCHARD OK
73010-6504
US

IV. Provider business mailing address

4350 WILL ROGERS PKWY STE 300
OKLAHOMA CITY OK
73108-1839
US

V. Phone/Fax

Practice location:
  • Phone: 405-485-3315
  • Fax:
Mailing address:
  • Phone: 405-943-1144
  • Fax: 405-639-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTY DEROIN
Title or Position: VP OF RCM
Credential:
Phone: 405-943-1144