OrganizationTimberlane Manor, Llc(Grace Living Center - Edmond)Skilled Nursing FacilityNursing & Custodial Care FacilitiesPractice Address2520 South Rankin, Edmond, OK 73013(405) 341-1433PECOS EnrollmentBased on the most recent information from CMS, provider Timberlane Manor, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:51 AM.Profile DetailsProvider ID1255425898Provider TypeOrganizationFull NameTimberlane Manor, LlcOther NameGrace Living Center - EdmondSubpartNoEnumeration Date10/3/2006Last Updated8/13/2020Contact InformationPractice LocationPractice Address2520 South Rankin, Edmond, OK 73013Phone(405) 341-1433Fax(405) 562-2128Mailing LocationMailing Address2520 South Rankin, Edmond, OK 73013Phone(405) 341-1433Fax(405) 562-2128Authorized OfficialNameDeroin, Kristy (Director Of Reimbursement)Phone(405) 943-1144Provider TaxonomiesCodeDescriptionLicenseCode314000000XPrimaryDescriptionSkilled Nursing FacilityNursing & Custodial Care FacilitiesLicenseNH5536-5536OklahomaProvider IdentifiersIDDescriptionIssuerID100810270BDescriptionMedicaidIssuerUnlistedOklahoma