NPIMap

Organization Active NPI

Laurel Health Care Company of Galesburg

  • Skilled Nursing Facility
  • Galesburg, MI
National Provider Identifier
1114972734
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
394150 Issued in MI
Legal business name
LAUREL HEALTH CARE COMPANY OF GALESBURG
Practice address
1080 N 35TH St
Galesburg, MI 49053-9727
Phone
(616) 665-7043
Fax
(616) 665-4080
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Authorized official

Name
Anis Khan
Title
Cfo
Phone
(248) 386-0300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 394150 MI
Skilled Nursing Facility 314000000X 394150 MI Primary

Addresses

Primary practice location

1080 N 35TH St
Galesburg, MI 49053-9727

Mailing address

4000 Town Ctr Ste 2000
Southfield, MI 48075-1415
Phone (248) 386-0300

Other identifiers 3

IdentifierTypeStateIssuer
3319728MedicaidMI
394150OtherMINURSING HOME LICENSE #
09796OtherMIBLUE CROSS BLUE SHIELD #

Other names 1

  • THE LAURELS OF GALESBURG Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111115000809 MI Part A Provider - Skilled Nursing Facility 6002080744 Practice locations: Galesburg, MI

Skilled nursing facility certification: CCN 235483

Legal name
LAUREL HEALTH CARE COMPANY OF GALESBURG
Doing business as
THE LAURELS OF GALESBURG
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 14, 1989
Last certification
Sep 19, 2024
Beds
93
Ownership / control type
Corporation
Multi-facility organization
Ciena Healthcare
Organization structure
CorporationProprietary
Incorporated
Dec 1, 1996 in MI
Enrollment address
1080 N 35TH St
Galesburg, MI 49053-9727
Nursing home name
THE LAURELS OF GALESBURG
Affiliated entity
CIENA HEALTHCARE/LAUREL HEALTH CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Laurels of GalesburgCCN 235483
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Feb 14, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9384.4 residents per day on average
Chain
Ciena Healthcare/Laurel Health Care81 facilities in the chain
Penalties (3 years)
4Fines totaling $145,115

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Laurel Health Care Company of Galesburg2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ciena Healthcare Management Inc Organization, Southfield, MI Corporation, Management services company, For-profit, Chain home office Operational/Managerial Control Jan 1, 2021 100%
Adp of the SNF Sep 2, 2025
Galesburg Senior Leasing, LLC Organization, Southfield, MI LLC, For-profit Adp of the SNF Jan 1, 2021
David Stobb Individual Corporate OfficerSecretary Feb 1, 2016
Adp of the SNF Jan 1, 2021
Anis Khan Individual Corporate OfficerTreasurer Feb 1, 2016
Operational/Managerial Control Feb 1, 2016
Adp of the SNF Feb 1, 2016
Laurel Acquisition Holding Corporation Organization, Westerville, OH Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2016 100%
Mohammad a. Qazi Individual 5% Or Greater Indirect Ownership InterestPresident Feb 1, 2016 100%
Corporate OfficerPresident Feb 1, 2016 100%
Corporate DirectorPresident Feb 1, 2016 100%
Operational/Managerial Control Feb 1, 2016
Neal H Deutsch Individual Adp of the SNF Jan 23, 2025
Mohammad a Qazi Living Trust Dated 09/26/97 Organization, West Bloomfield, MI For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2016 100%
Adp of the SNF Feb 1, 2016
Justin P Di Rezze Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Laurel Health Care Holdings, Inc. Organization, Westerville, OH Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2016 100%
Chad Underly Individual Operational/Managerial Control Oct 24, 2024
Adp of the SNF Oct 24, 2024
Individual Adp of the SNF Jan 17, 2022
Anna Gardina Individual Adp of the SNF Jan 23, 2025
Individual Adp of the SNF Dec 1, 2024
Select Rehabilitation, LLC Organization, Glenview, IL LLC, For-profit Adp of the SNF Jul 1, 2024
Individual Adp of the SNF Mar 1, 2022
Zenith Financial Group, LLC Organization, Taylor, MI LLC, For-profit Adp of the SNF Mar 1, 2022

Owners & managing parties with NPI records 2

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

Facilities with the same owner 80

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 80

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1114972734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 TOWN CTR STE 2000",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480751415",
            "telephone_number": "248-386-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 N 35TH ST",
            "city": "GALESBURG",
            "state": "MI",
            "postal_code": "490539727",
            "telephone_number": "616-665-7043",
            "fax_number": "616-665-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUREL HEALTH CARE COMPANY OF GALESBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "ANIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "248-386-0300"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MI",
            "license": "394150",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "394150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3319728",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING HOME LICENSE #",
            "identifier": "394150",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD #",
            "identifier": "09796",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE LAURELS OF GALESBURG",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE LAURELS OF GALESBURG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galesburg, MI

Sources for this page

Verify at the official NPI Registry.