NPIMap

Organization Active NPI

Regency on the Lake-Fort Gratiot, LLC

  • Skilled Nursing Facility
  • Fort Gratiot, MI
National Provider Identifier
1356491369
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
REGENCY ON THE LAKE-FORT GRATIOT, LLC
Practice address
5669 Lakeshore Rd
Fort Gratiot, MI 48059-2817
Phone
(810) 385-7260
NPI assigned
Jan 11, 2007
Organization subpart
Yes
Parent organization
CIENA HEALTHCARE MANAGEMENT, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Authorized official

Name
Mr. Mohammad Ashraf Qazi
Title
Ceo
Phone
(248) 386-0300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5669 Lakeshore Rd
Fort Gratiot, MI 48059-2817

Mailing address

5669 Lakeshore Rd
Fort Gratiot, MI 48059-2817

Other identifiers 2

IdentifierTypeStateIssuer
09594OtherMIBCBSM PROVIDER CODE
4988052MedicaidMI

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
O20060417000011 MI Part A Provider - Skilled Nursing Facility 1254340482 Practice locations: Fort Gratiot, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356491369. Details of each certification follow.

Skilled nursing facility certification: CCN 235621

Legal name
REGENCY ON THE LAKE-FORT GRATIOT, LLC
Doing business as
REGENCY ON THE LAKE-FORT GRATIOT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 18, 2007
Last certification
Jun 6, 2024
Beds
130
Ownership / control type
Corporation
Organization structure
LLCProprietary
Incorporated
Mar 4, 2005 in MI
Enrollment address
5669 Lakeshore Rd
Fort Gratiot, MI 48059-2817
Nursing home name
REGENCY ON THE LAKE - FORT GRATIOT
Affiliated entity
CIENA HEALTHCARE/LAUREL HEALTH CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Regency on the Lake - Fort GratiotCCN 235621 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 18, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
130120.6 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
23D1053226Regency on the Lake Fort Gratiot5669 Lakeshore, Fort Gratiot, MI 48059Certificate of waiverApr 17, 2028

National Provider Directory

National Provider Directory

Locations

5669 Lakeshore Rd
Fort Gratiot, MI 48059
Phone (810) 385-7260

Ownership & related parties

All disclosed owners & managing parties 18

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 Dec 15, 2006
Adp of the SNF Mar 25, 2025
Individual Adp of the SNF Mar 1, 2022
Individual Adp of the SNF Dec 15, 2006
Farrukh Zaman Naqvi Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Individual Adp of the SNF Jan 17, 2022
Cheryl a Canto Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Anis Khan Individual Operational/Managerial ControlCfo for Management Company Dec 15, 2006
Managing Control - Governing BodyManager Dec 15, 2006
Adp of the SNF Dec 15, 2006
Mohammad a. Qazi Individual 5% Or Greater Indirect Ownership InterestManager Sep 9, 2022 100%
Operational/Managerial Control Dec 15, 2006
Managing Control - Governing BodyManager Dec 15, 2006
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 Sep 9, 2022 100%
Organization, Southfield, MI LLC, Holding company, For-profit, Owned by another organization or individual Direct Ownership Interest Sep 9, 2022 100%
Mohammad Qazi 2022 Children's Trust Uad 5-4-2022 Organization, West Bloomfield, MI 5% Or Greater Indirect Ownership Interest Sep 9, 2022 99%
Lisa Michalak Individual Operational/Managerial Control Oct 28, 2024
Adp of the SNF Oct 28, 2024
Organization, Southfield, MI LLC, For-profit Adp of the SNF Dec 15, 2006
Organization, Taylor, MI LLC, For-profit Adp of the SNF Mar 25, 2025
Organization, Glenview, IL LLC, For-profit Adp of the SNF Mar 25, 2025
Anna Gardina Individual Adp of the SNF Jan 23, 2025
Individual Adp of the SNF Dec 1, 2024

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 76

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

View all 76

Practitioners & affiliated clinicians

Practitioners 3

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 4

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": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789516800000",
    "number": "1356491369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5669 LAKESHORE RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480592817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5669 LAKESHORE RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480592817",
            "telephone_number": "810-385-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY ON THE LAKE-FORT GRATIOT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIENA HEALTHCARE MANAGEMENT, INC",
        "enumeration_date": "2007-01-11",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A",
        "authorized_official_last_name": "QAZI",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "ASHRAF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-386-0300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PROVIDER CODE",
            "identifier": "09594",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4988052",
            "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": []
}

Other providers in Fort Gratiot, MI

Sources for this page

Verify at the official NPI Registry.