NPIMap

Organization Active NPI

Wilshire Nursing Center LLC

Doing business as Grace Living Center - Wilshire

  • Skilled Nursing Facility
  • Oklahoma City, OK
National Provider Identifier
1902901861
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH5541-5541 Issued in OK
Legal business name
WILSHIRE NURSING CENTER LLC
Doing business as
Grace Living Center - Wilshire
The Wilshire Skilled Nursing and Therapy
Practice address
505 E Wilshire Blvd
Oklahoma City, OK 73105-1011
Phone
(405) 478-0531
Fax
(405) 478-3520
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Authorized official

Name
Mike Dimond
Title
Manager
Phone
(405) 943-1144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH5541-5541 OK Primary

Addresses

Primary practice location

505 E Wilshire Blvd
Oklahoma City, OK 73105-1011

Mailing address

505 E Wilshire Blvd
Oklahoma City, OK 73105-1011
Phone (405) 478-0531

Other identifiers 1

IdentifierTypeStateIssuer
100776920AMedicaidOK

Other names 2

  • Grace Living Center - Wilshire Doing business as
  • The Wilshire 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
O20191003000393 OK Part A Provider - Skilled Nursing Facility 9032028311 Practice locations: Oklahoma City, OK

Skilled nursing facility certification: CCN 375189

Legal name
WILSHIRE NURSING CENTER LLC
Doing business as
THE WILSHIRE SKILLED NURSING AND THERAPY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1994
Last certification
Sep 24, 2024
Beds
56
Ownership / control type
Corporation
Most recent change of ownership
Jul 1, 2019
Organization structure
LLCProprietary
Enrollment address
505 East Wilshire Boulevard
Oklahoma City, OK 73105-1011
Nursing home name
THE WILSHIRE SKILLED NURSING AND THERAPY
Affiliated entity
BRIDGES HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Wilshire Skilled Nursing and TherapyCCN 375189 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5640.5 residents per day on average
Chain
Bridges Health33 facilities in the chain

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
37D0667699Wilshire Skilled Nursing and Therapy, the505 E Wilshire, Oklahoma City, OK 73105Certificate 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 Employee 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.

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": "1759104000000",
    "number": "1902901861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E WILSHIRE BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731051011",
            "telephone_number": "405-478-0531",
            "fax_number": "405-478-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E WILSHIRE BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731051011",
            "telephone_number": "405-478-0531",
            "fax_number": "405-478-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSHIRE NURSING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "DIMOND",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "405-943-1144"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH5541-5541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100776920A",
            "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 - Wilshire",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Wilshire Skilled Nursing and Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.