NPIMap

Organization Active NPI

Royalton Manor, LLC

  • Skilled Nursing Facility
  • Saint Joseph, MI
National Provider Identifier
1598816423
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ROYALTON MANOR, LLC
Practice address
288 Peace Boulevard
St Joseph, MI 49085
Phone
(269) 556-9050
NPI assigned
Jan 16, 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

288 Peace Boulevard
St Joseph, MI 49085

Mailing address

288 Peace Boulevard
St Joseph, MI 49085

Other identifiers 2

IdentifierTypeStateIssuer
5184958MedicaidMI
09792OtherBCBSM

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
O20060418000026 MI Part A Provider - Skilled Nursing Facility 0345259552 Practice locations: Saint Joseph, MI

Skilled nursing facility certification: CCN 235623

Legal name
ROYALTON MANOR, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 16, 2007
Last certification
Apr 16, 2025
Beds
123
Ownership / control type
Corporation
Multi-facility organization
Ciena Healthcare
Organization structure
LLCProprietary
Incorporated
Apr 7, 2005 in MI
Enrollment address
288 Peace Blvd
Saint Joseph, MI 49085-9562
Nursing home name
ROYALTON MANOR, LLC
Affiliated entity
CIENA HEALTHCARE/LAUREL HEALTH CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Royalton Manor, LLCCCN 235623 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Feb 16, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
123112.5 residents per day on average
Chain
Ciena Healthcare/Laurel Health Care81 facilities in the chain
Penalties (3 years)
3Fines totaling $173,966

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
23D1053227Royalton Manor288 Peace Blvd, Saint Joseph, MI 49085Certificate of waiverApr 17, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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 16, 2007
Adp of the SNF Mar 21, 2025
Individual Adp of the SNF Jan 17, 2022
Organization, Taylor, MI LLC, For-profit Adp of the SNF Mar 21, 2025
Individual Adp of the SNF Feb 16, 2007
Organization, Glenview, IL LLC, For-profit Adp of the SNF Mar 21, 2025
Anis Khan Individual Operational/Managerial Control Dec 16, 2007
Managing Control - Governing BodyManager Dec 16, 1997
Adp of the SNF Dec 16, 1997
Mohammad a. Qazi Individual 5% Or Greater Indirect Ownership InterestManager Dec 16, 2007 100%
Operational/Managerial Control Dec 16, 2007
Managing Control - Governing BodyManager Dec 16, 2007
Adp of the SNF Dec 16, 2007
Neal H Deutsch Individual Adp of the SNF Aug 1, 2009
Mohammad a Qazi Living Trust Dated 09/26/97 Organization, West Bloomfield, MI For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 16, 2007 100%
Adp of the SNF Dec 16, 2007
Ali Raza Individual Operational/Managerial Control Mar 19, 2024
Adp of the SNF Mar 19, 2024
Keith L Papendick Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Individual Adp of the SNF Mar 1, 2022
Anna Gardina Individual Adp of the SNF Aug 1, 2009
Individual Adp of the SNF Dec 1, 2024
Organization, Southfield, MI LLC, For-profit Adp of the SNF Feb 16, 2007

Owners & managing parties with NPI records 1

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.

Affiliated clinicians 2

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789516800000",
    "number": "1598816423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "288 PEACE BOULEVARD",
            "city": "ST JOSEPH",
            "state": "MI",
            "postal_code": "49085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "288 PEACE BOULEVARD",
            "city": "ST JOSEPH",
            "state": "MI",
            "postal_code": "49085",
            "telephone_number": "269-556-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYALTON MANOR, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIENA HEALTHCARE MANAGEMENT, INC",
        "enumeration_date": "2007-01-16",
        "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5184958",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "09792",
            "state": null
        }
    ],
    "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 Saint Joseph, MI

Sources for this page

Verify at the official NPI Registry.