NPIMap

Organization Active NPI

Mangum Nursing Center, LLC

Doing business as Grace Living Center - Mangum

  • Skilled Nursing Facility
  • Mangum, OK
National Provider Identifier
1437254158
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH2801-2801 Issued in OK
Legal business name
MANGUM NURSING CENTER, LLC
Doing business as
Grace Living Center - Mangum
Mangum Skilled Nursing and Therapy
Practice address
320 Carey Ave
Mangum, OK 73554-1624
Phone
(580) 782-3346
Fax
(580) 782-3126
NPI assigned
Sep 14, 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
Title
Director of RCM
Phone
(405) 943-1144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH2801-2801 OK Primary

Addresses

Primary practice location

320 Carey Ave
Mangum, OK 73554-1624

Mailing address

320 Carey Ave
Mangum, OK 73554-1624
Phone (580) 782-3346

Other identifiers 1

IdentifierTypeStateIssuer
100776780AMedicaidOK

Other names 2

  • GRACE LIVING CENTER - MANGUM Doing business as
  • Mangum Skilled Nursing and Therapy Doing business as

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
O20190830001323 OK Part A Provider - Skilled Nursing Facility 2769391937 Practice locations: Mangum, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437254158. Details of each certification follow.

Skilled nursing facility certification: CCN 375207

Legal name
MANGUM NURSING CENTER, LLC
Doing business as
MANGUM SKILLED NURSING AND THERAPY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1995
Last certification
Dec 4, 2024
Beds
140
Ownership / control type
Partnership
Most recent change of ownership
Jul 1, 2019
Organization structure
LLCProprietary
Enrollment address
320 Carey Ave
Mangum, OK 73554-1624
Nursing home name
MANGUM SKILLED NURSING AND THERAPY
Affiliated entity
BRIDGES HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mangum Skilled Nursing and TherapyCCN 375207 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Partnership
Certified
Jan 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
14027.7 residents per day on average
Chain
Bridges Health33 facilities in the chain
Penalties (3 years)
1Fines totaling $14,069

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D0472321Mangum Skilled Nursing and Therapy320 Carey, Mangum, OK 73554Certificate of waiverAug 31, 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 30, 2019
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 Dec 31, 2020
Operational/Managerial ControlPresident 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": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1437254158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 CAREY AVE",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "735541624",
            "telephone_number": "580-782-3346",
            "fax_number": "580-782-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 CAREY AVE",
            "city": "MANGUM",
            "state": "OK",
            "postal_code": "735541624",
            "telephone_number": "580-782-3346",
            "fax_number": "580-782-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGUM NURSING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "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 RCM",
        "authorized_official_telephone_number": "405-943-1144"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH2801-2801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100776780A",
            "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": [
        {
            "organization_name": "GRACE LIVING CENTER - MANGUM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRACE LIVING CENTER - MANGUM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mangum Skilled Nursing and Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mangum, OK

Sources for this page

Verify at the official NPI Registry.