NPIMap

Organization Active NPI

University Northwest, LLC

Doing business as Grace Living Center - University NW

  • Skilled Nursing Facility
  • Tahlequah, OK
National Provider Identifier
1487759023
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH1101-1101 Issued in OK
Legal business name
UNIVERSITY NORTHWEST, LLC
Doing business as
Grace Living Center - University NW
University Park Memory Care Skilled Nursing and Therapy
Practice address
1201 N Vinita Ave
Tahlequah, OK 74464-6429
Phone
(918) 456-6181
Fax
(918) 456-1512
NPI assigned
Sep 14, 2006
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 Reimbursement
Phone
(405) 943-1144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH1101-1101 OK Primary

Addresses

Primary practice location

1201 N Vinita Ave
Tahlequah, OK 74464-6429

Mailing address

1201 N Vinita Ave
Tahlequah, OK 74464-6429
Phone (918) 456-6181

Other identifiers 1

IdentifierTypeStateIssuer
100776450AMedicaidOK

Other names 2

  • GRACE LIVING CENTER - UNIVERSITY NW Doing business as
  • UNIVERSITY PARK MEMORY CARE 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
O20030605000003 OK Part A Provider - Skilled Nursing Facility 5496664534 Practice locations: Tahlequah, OK

Skilled nursing facility certification: CCN 375185

Legal name
UNIVERSITY NORTHWEST LLC
Doing business as
UNIVERSITY PARK SKILLED NURSING AND THERAPY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1994
Last certification
Mar 10, 2025
Beds
139
Ownership / control type
Partnership
Organization structure
LLCProprietary
Enrollment address
1201 N Vinita Ave
Tahlequah, OK 74464-6429
Nursing home name
UNIVERSITY PARK SKILLED NURSING AND THERAPY MEMORY
Affiliated entity
BRIDGES HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
University Park Skilled Nursing and Therapy MemoryCCN 375185 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Partnership
Certified
Sep 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
13947.9 residents per day on average
Chain
Bridges Health33 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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 Contracted Managing EmployeeDirector of Reimbursement Apr 1, 2020
W-2 Managing EmployeeDirector of Reimbursement Apr 1, 2020
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 Apr 1, 2020
Operational/Managerial ControlPresident Apr 1, 2020
Joanna Crane Individual W-2 Managing Employee Dec 17, 2013

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 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

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": "1487759023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 N VINITA AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744646429",
            "telephone_number": "918-456-6181",
            "fax_number": "918-456-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N VINITA AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744646429",
            "telephone_number": "918-456-6181",
            "fax_number": "918-456-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY NORTHWEST, 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 REIMBURSEMENT",
        "authorized_official_telephone_number": "405-943-1144"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH1101-1101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100776450A",
            "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 - UNIVERSITY NW",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRACE LIVING CENTER - UNIVERSITY NW",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UNIVERSITY PARK MEMORY CARE SKILLED NURSING AND THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.