NPIMap

Organization Active NPI

Fenton Healthcare LLC

Doing business as Fenton HealthCare

  • Skilled Nursing Facility
  • Fenton, MI
National Provider Identifier
1114974391
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
254050 Issued in MI
Legal business name
FENTON HEALTHCARE LLC
Doing business as
Fenton HealthCare
Practice address
512 Beach St
Fenton, MI 48430-3122
Phone
(810) 629-4117
Fax
(810) 629-0491
NPI assigned
May 31, 2006
Last updated
Sep 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

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

Authorized official

Name
Larry D. White
Title
Manager
Phone
(810) 629-4117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 254050 MI Primary

Addresses

Primary practice location

512 Beach St
Fenton, MI 48430-3122

Mailing address

512 Beach St
Fenton, MI 48430-3122
Phone (810) 629-4117

Other identifiers 1

IdentifierTypeStateIssuer
4639937MedicaidMI

Other names 1

  • Fenton HealthCare Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609000688 MI Part A Provider - Skilled Nursing Facility 9830172196 Practice locations: Fenton, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114974391. Details of each certification follow.

Skilled nursing facility certification: CCN 235482

Legal name
FENTON HEALTHCARE, LLC
Doing business as
FENTON HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jan 25, 1989
Last certification
Oct 3, 2024
Beds
92
Ownership / control type
Individual
Organization structure
LLCProprietary
Enrollment address
512 Beach St
Fenton, MI 48430-3122
Nursing home name
FENTON HEALTHCARE
Affiliated entity
CIENA HEALTHCARE/LAUREL HEALTH CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fenton HealthcareCCN 235482 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Jan 25, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9266.7 residents per day on average
Chain
Ciena Healthcare/Laurel Health Care81 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
23D0677094Fenton Healthcare512 Beach St, Fenton, MI 48430Certificate of waiverAug 31, 2026

National Provider Directory

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 Jul 1, 2018
Adp of the SNF Mar 25, 2025
Individual Adp of the SNF Dec 1, 2024
Individual Adp of the SNF Jan 17, 2022
Organization, Glenview, IL LLC, For-profit Adp of the SNF Mar 25, 2025
Anis Khan Individual Operational/Managerial ControlCfo Jul 1, 2018
Managing Control - Governing BodyManager Jul 1, 2018
Adp of the SNF Jul 1, 2018
Individual Adp of the SNF Jul 1, 2018
Organization, Southfield, MI LLC, Holding company, For-profit Adp of the SNF Feb 21, 2025
Organization, Carmel, IN Financial institution Adp of the SNF Mar 25, 2025
Mohammad a. Qazi Individual Operational/Managerial Control Jul 1, 2018
Managing Control - Governing BodyManager Jul 1, 2018
Indirect Ownership Interest Feb 21, 2025 100%
Individual Adp of the SNF Jul 1, 2018
Organization, West Bloomfield, MI For-profit Adp of the SNF Feb 21, 2025
Mohammad a Qazi Living Trust Dated 09/26/97 Organization, West Bloomfield, MI For-profit, Owned by another organization or individual Indirect Ownership Interest Feb 21, 2025 100%
Organization, Southfield, MI LLC, Holding company, For-profit, Owned by another organization or individual Direct Ownership Interest Feb 21, 2025 100%
Individual Adp of the SNF Jun 18, 2018
Organization, Southfield, MI LLC, For-profit Adp of the SNF Jul 1, 2018
Individual Adp of the SNF Mar 1, 2022
Organization, Taylor, MI LLC, For-profit Adp of the SNF Mar 25, 2025

Facilities with the same owner 47

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

View all 47

Practitioners & affiliated clinicians

Practitioners 1

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 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": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789430400000",
    "number": "1114974391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 BEACH ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303122",
            "telephone_number": "810-629-4117",
            "fax_number": "810-629-0491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 BEACH ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303122",
            "telephone_number": "810-629-4117",
            "fax_number": "810-629-0491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FENTON HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "810-629-4117"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "254050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4639937",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "affiliationName": "Ability Network Inc",
            "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": "Fenton HealthCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fenton, MI

Sources for this page

Verify at the official NPI Registry.