NPIMap

Organization Active NPI

Rebold Manor L L C

  • Skilled Nursing Facility
  • Okmulgee, OK
National Provider Identifier
1144326489
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH5608-5608 Issued in OK
Legal business name
REBOLD MANOR L L C
Practice address
1701 E 6TH St
Okmulgee, OK 74447-4807
Phone
(918) 756-1967
Fax
(918) 756-4271
NPI assigned
Sep 15, 2006
Last updated
Feb 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristy Deroin, MBA
Title
Director of Reimbursement
Phone
(405) 943-1144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH5608-5608 OK Primary

Addresses

Primary practice location

1701 E 6TH St
Okmulgee, OK 74447-4807

Mailing address

1701 E 6TH St
Okmulgee, OK 74447-4807
Phone (918) 756-1967

Other identifiers 1

IdentifierTypeStateIssuer
200073640AMedicaidOK

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050713000054 OK Part A Provider - Skilled Nursing Facility 5395771141 Practice locations: Okmulgee, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144326489. Details of each certification follow.

Skilled nursing facility certification: CCN 375494

Legal name
REBOLD MANOR L L C
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 15, 2005
Last certification
May 22, 2025
Beds
114
Ownership / control type
Partnership
Organization structure
LLCProprietary
Enrollment address
1701 E 6TH St
Okmulgee, OK 74447-4807

Care Compare: Nursing home

Medicare Care Compare
Listed as
Woodlands Skilled Nursing and TherapyCCN 375494 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Partnership
Certified
Aug 15, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11451.1 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristy Deroin Individual W-2 Managing EmployeeDirector of Reimbursement Jun 1, 1997
Bridges Esop, Inc Organization, Oklahoma City, OK Corporation 5% Or Greater Direct Ownership Interest Dec 31, 2020 100%
Operational/Managerial Control Dec 31, 2020 100%
Bridges Employee Stock Ownership Trust Organization, Lisle, IL Created for acquisition 5% Or Greater Indirect Ownership Interest Dec 31, 2020 100%
William Brett Coble Individual Corporate OfficerPresident/Manager Dec 31, 2020
Operational/Managerial ControlPresident/Manager Dec 31, 2020

Facilities with the same owner 33

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 33

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1144326489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E 6TH ST",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744474807",
            "telephone_number": "918-756-1967",
            "fax_number": "918-756-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E 6TH ST",
            "city": "OKMULGEE",
            "state": "OK",
            "postal_code": "744474807",
            "telephone_number": "918-756-1967",
            "fax_number": "918-756-4271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBOLD MANOR L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A",
        "authorized_official_last_name": "DEROIN",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "405-943-1144",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH5608-5608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200073640A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Okmulgee, OK

Sources for this page

Verify at the official NPI Registry.