MEDICARE: SENIOR VILLAGE OPERATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538661905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR VILLAGE OPERATIONS LLC

Provider Business Mailing Address
First Line	:	4350 WILL ROGERS PKWY STE 300
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108-1839
Country	:	US
Telephone Number	:	405-943-1144
Fax Number	:	405-639-2742

Provider Business Practice Location Address
First Line	:	1104 N MADISON AVE
Second Line	:
City	:	BLANCHARD
State	:	OK
Zip	:	73010-6504
Country	:	US
Telephone Number	:	405-485-3315
Fax Number	:

Authorized Official
Title or Position	:	VP OF RCM
Name	:	KRISTY DEROIN
Credential	:
Telephone Number	:	405-943-1144

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	09/30/2025

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Directions to “SENIOR VILLAGE OPERATIONS LLC ” Practice Location

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