NPIMap

Organization Active NPI

Putnam City Convalescent Center, LLC

Doing business as Grace Living Center - Bethany

  • Skilled Nursing Facility
  • Bethany, OK
National Provider Identifier
1801991534
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH5518-5518 Issued in OK
Legal business name
PUTNAM CITY CONVALESCENT CENTER, LLC
Doing business as
Grace Living Center - Bethany
The Grand at Bethany Skilled Nursing and Therapy
Practice address
7000 NW 32ND St
Bethany, OK 73008-3910
Phone
(405) 789-7242
Fax
(405) 495-7562
NPI assigned
Sep 14, 2006
Last updated
Oct 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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 NH5518-5518 OK Primary

Addresses

Primary practice location

7000 NW 32ND St
Bethany, OK 73008-3910

Mailing address

7000 NW 32ND St
Bethany, OK 73008-3910
Phone (405) 789-7242

Other identifiers 1

IdentifierTypeStateIssuer
100776760AMedicaidOK

Other names 2

  • GRACE LIVING CENTER - BETHANY Doing business as
  • The Grand at Bethany 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
O20030320000033 OK Part A Provider - Skilled Nursing Facility 5395654560 Practice locations: Bethany, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801991534. Details of each certification follow.

Skilled nursing facility certification: CCN 375107

Legal name
PUTNAM CITY CONVALESCENT CENTER, LLC
Doing business as
THE GRAND AT BETHANY SKILLED NURSING AND THERAPY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 19, 1990
Last certification
Sep 3, 2024
Beds
161
Ownership / control type
Partnership
Organization structure
LLCProprietary
Enrollment address
7000 NW 32ND St
Grace Living Center - Bethany
Bethany, OK 73008-3910
Nursing home name
THE GRAND AT BETHANY SKILLED NURSING AND THERAPY
Affiliated entity
BRIDGES HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Grand at Bethany Skilled Nursing and TherapyCCN 375107 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Partnership
Certified
Oct 19, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
161110.3 residents per day on average
Chain
Bridges Health33 facilities in the chain
Penalties (3 years)
2Fines totaling $22,919

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
37D0469435Grand at Bethany Skilled Nursing and Therapy, the7000 NW 32ND, Bethany, OK 73008Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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 Corporate DirectorDirector of Revenue Cycle Jan 1, 2021
Adp of the SNF Jan 1, 2021
Bridges Esop, Inc Organization, Oklahoma City, OK Created for acquisition, Corporation, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 31, 2020 100%
Orix Real Estate Capital LLC Organization, Dallas, TX LLC 5% Or Greater Mortgage Interest Oct 1, 2014 60%
FLP, L.L.C. Organization, Oklahoma City, OK LLC Adp of the SNF Dec 3, 2025
Bridges Employee Stock Ownership Trust Organization, Lisle, IL Created for acquisition 5% Or Greater Indirect Ownership Interest Dec 31, 2020 100%
William Griffin Individual Corporate DirectorDirector Jan 1, 2021 100%
Adp of the SNF Jan 1, 2021
Michael a Boone Individual Managing Control - Governing BodyRegional Manager Jan 1, 2021
Adp of the SNF Jan 1, 2021
Bethlinwood, LLC Organization, Oklahoma City, OK LLC Adp of the SNF Jan 1, 1998
William Brett Coble Individual Corporate OfficerPresident Dec 31, 2020 100%
Adp of the SNF Jan 1, 2021
Magesh Sathaiah Individual Operational/Managerial Control Oct 1, 2025
Adp of the SNF Oct 1, 2025
Amity Care, LLC Organization, Oklahoma City, OK LLC, Chain home office Adp of the SNF Dec 3, 2025
Dennis Long Individual Adp of the SNF Jan 1, 2021
Robert Duncan Individual Adp of the SNF May 2, 2022
Renew Properties, LLC Organization, Oklahoma City, OK LLC Adp of the SNF Mar 1, 2018
Autumn Calfe Individual Operational/Managerial Control May 8, 2025
Adp of the SNF May 8, 2025
Kenneth D. Greiner III Revocable Trust Organization, Oklahoma City, OK 5% Or Greater Security Interest Dec 31, 2020 11.5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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 5

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.

Affiliated clinicians 3

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": "1760400000000",
    "number": "1801991534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 NW 32ND ST",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730083910",
            "telephone_number": "405-789-7242",
            "fax_number": "405-495-7562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 NW 32ND ST",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730083910",
            "telephone_number": "405-789-7242",
            "fax_number": "405-495-7562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM CITY CONVALESCENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "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": "NH5518-5518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100776760A",
            "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 SteB",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "GRACE LIVING CENTER - BETHANY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRACE LIVING CENTER - BETHANY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Grand at Bethany Skilled Nursing and Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethany, OK

Sources for this page

Verify at the official NPI Registry.