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GRAND LAKE VILLA
NPI 1154628790
Skilled Nursing Facility in Grove, OK

Active since February 17, 2011CLIA 37D0857570 · Waiver
5/5
Overall Rating
103 HAR-BER RD, GROVE, OK 74345(918) 786-2276(918) 786-4526 Get Directions Write a Review

NPPES record last updated: January 19, 2022. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Grand Lake Villa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND LAKE VILLA (NPI 1154628790) is a healthcare organization registered as a skilled nursing facility in Grove, Oklahoma and active in the NPI registry since February 2011. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Chris Brogdon, Manager, as its authorized official.

NPPES Registry Identity

NPI1154628790
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameOAK LAKE, LLC
Location Address103 HAR-BER RDGrove, OK 74345-0547
Mailing Address103 Har-ber RoadGrove, OK 74345-0547 · (918) 786-2276 · Fax (918) 786-4526
Phone(918) 786-2276
Fax(918) 786-4526
Organization SubpartNo
Authorized OfficialChris BrogdonManager · (770) 650-8793
Enumeration DateFebruary 17, 2011
Last NPPES UpdateJanuary 19, 2022
NPPES CertifiedJanuary 19, 2022
✔ NPI 1154628790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
103 HAR-BER RD, Grove, OK 74345
Open in Google Maps ↗

Other Names 1

Doing Business AsGrand Lake Villa

Other Identifiers 1

Medicaid20059540AOK

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Oklahoma.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D0857570

Grand Lake Villa Oak Lake, LLC · Grove, OK
Active · expires Aug 31, 2026
CLIA Number37D0857570
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorCheralyn Tims
Laboratory Phone(918) 786-2276
Laboratory LocationGrand Lake Villa Oak Lake, LLC103 Har-Ber Rd, Grove, OK 74345
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Grand Lake Villa (CMS certification number 375116), from CMS Care Compare.

Grand Lake Villa

Nursing home · Grove, OK
5/5 CMS Overall Rating
OwnershipFor profit - Limited Liability company
CMS Certification Number375116
Certified Beds100 beds56 residents per day on average
Medicare & Medicaid Participant SinceJanuary 7, 1992
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
3/5
Long-Stay Quality
Quality of care delivered to long-term residents.
4/5
Short-Stay Quality
Quality of care delivered to short-term and rehabilitation residents.
3/5
Staffing
Based on nursing staff hours relative to resident needs.
5/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
32.67
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 2.69 · LPN 0.35 · RN 0.83
3.87 hrs per resident per day
Weekend Nurse Staffing
3.76 hrs per resident per day
Physical Therapist Staffing
0.01 hrs per resident per day
Nursing Staff Turnover
Share of nursing staff who left the facility within the past year.
43.1%
Registered Nurse Turnover
20%
Administrators Who Have Left
In the past year.
0
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
1
Substantiated Complaints
3
Infection-Control Citations
0
Fines
0
Medicare Payment Denials
0
Total Penalties
0
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Oak Lake, LLC's NPI number?

The NPI number for Oak Lake, LLC is 1154628790. It was assigned to this organization in the NPPES registry on February 17, 2011. The provider is doing business as Grand Lake Villa.

Where is Oak Lake, LLC located?

Oak Lake, LLC is located at 103 Har-Ber Rd, Grove, OK 74345. The listed phone number is (918) 786-2276.

What is Oak Lake, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Oak Lake, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D0857570) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Oak Lake, LLC a Medicare-certified nursing home?

Yes. Grand Lake Villa is a Medicare-certified nursing home with 100 certified beds.

What quality rating does Oak Lake, LLC have?

CMS rates Grand Lake Villa 5 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

What insurance does Oak Lake, LLC accept?

Health plans from Blue Cross and Blue Shield of Oklahoma list Oak Lake, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Oak Lake, LLC was last updated on January 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.