Deckerville Nursing Center, LLC
Organization Active NPI Skilled Nursing Facility · Deckerville, MI
NPI 1669479804 · NPPES record last updated Aug 21, 2026
Key facts
- NPI
- 1669479804
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- DECKERVILLE NURSING CENTER, LLC
- Practice address
- 3387 Ella
Deckerville, MI 48427-9441 - Phone
- (810) 376-2145
- Fax
- (810) 376-4093
- NPI assigned
- Jul 1, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- CIENA HEALTHCARE MANAGEMENT, INC
Authorized official
- Name
- Mr. Mohammad Ashraf Qazi
- Title
- Ceo
- Phone
- (248) 386-0300
Owners & managing parties with NPI records 1
-
Nick Buttar, M.D.
Facilities with the same owner 76
Practitioners 1
-
Nick Buttar, M.D.
Affiliated clinicians 1
-
Nick Buttar, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Autumnwood of Deckerville
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Oct 3, 1985
- Certified beds
- 84 · 79.9 residents per day on average
- Chain
- Ciena Healthcare/Laurel Health Care
- Penalties (3 years)
- 2 · fines totaling $61,621
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0886046 | Autumnwood of Deckerville | Certificate of waiver | May 11, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Skilled nursing facility certification: CCN 235446
- Legal name
- DECKERVILLE NURSING CENTER LLC
- Doing business as
- AUTUMNWOOD OF DECKERVILLE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 3, 1985
- Last certification
- Mar 6, 2025
- Beds
- 84
- Ownership / control type
- Corporation
- Multi-facility organization
- CIENA Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Sep 27, 1999 in MI
- Enrollment address
- 3387 Ella St
Deckerville, MI 48427-7720 - Nursing home name
- AUTUMNWOOD OF DECKERVILLE
- Affiliated entity
- CIENA HEALTHCARE/LAUREL HEALTH CARE
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Ciena Healthcare Management Inc |
Operational/Managerial Control | Oct 1, 1999 | |
| Adp of the SNF | Apr 8, 2025 | ||
| Anis Khan |
Operational/Managerial Control | Oct 1, 1999 | |
| Managing Control - Governing Body |
Oct 1, 1999 | ||
| Adp of the SNF | Oct 1, 1999 | ||
| |
Adp of the SNF | Mar 1, 2022 | |
| Mohammad a. Qazi |
5% Or Greater Indirect Ownership Interest |
Oct 1, 1999 | 100% |
| Operational/Managerial Control | Oct 1, 1999 | ||
| Managing Control - Governing Body |
Oct 1, 1999 | ||
| Adp of the SNF | Oct 1, 1999 | ||
| Mohammad a Qazi Living Trust Dated 09/26/97 |
5% Or Greater Direct Ownership Interest | Oct 1, 1999 | 100% |
| Adp of the SNF | Oct 1, 1999 | ||
| Nick S Buttar |
Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| |
Adp of the SNF | Oct 1, 1999 | |
| |
Adp of the SNF | Dec 1, 2024 | |
| |
Adp of the SNF | Mar 18, 2025 | |
| |
Adp of the SNF | Jan 3, 2003 | |
| |
Adp of the SNF | Mar 18, 2025 | |
| |
Adp of the SNF | Jan 17, 2022 | |
| Kerry Regentin |
Operational/Managerial Control | Jan 3, 2024 | |
| Adp of the SNF | Jan 3, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030131000023 | MI | Part a Provider - Skilled Nursing Facility | 2163330853 | Practice locations: Deckerville, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
3387 Ella
Deckerville, MI 48427-9441
Mailing address
3387 Ella
Deckerville, MI 48427-9441
Phone (810) 376-2145
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4152673 | Medicaid | MI | |
| S9515 | Other | MI | BCBSM |
Other names
- Autumnwood of Deckerville
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Flinkprotect.cudasvc.com%2Furl%3Fa%3Dhttps%253a%252f%252fesmd.abilitynetwork.com%253a8291%252fGateway%252fDocumentSubmission%252f2_0%252fNhinService%252fXDRRequest_Service%26c%3DE%2C1%2ClWqpZghiGS4Kz40sJYqlAK3sJu9fxnFubX3trOqWyyGwocDS9c9ndiHTvAYldW3wtkbJUZ7sCuXElbOQx7vEJdnDS39FxD5Zu6xVfu363H-dEg%2C%2C%26typo%3D1&data=05%7C02%7Ctami.hunt%40cienahealthcare.com%7C1ac919d738a747084c8608deffa091ae%7C2fd38080778e49eb84ff28e577d2d88c%7C0%7C0%7C639229262332980962%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=GrjufU2aWUL%2Bk6HrdtsSvhSlNt1mOiShWY49GDcbd6s%3D&reserved=0 | Other | Ability Network Inc |
Other providers in Deckerville, MI
- Deckerville Community Hospital, Inc.
- Deckerville Community Hospital, Inc.
- Deckerville Community Hospital, Inc.
- Deckerville Community Hospital, Inc.
- Deckerville Community Hospital, Inc.
- Pany Decossard
- Carrie V Eugster
- For the Family Counseling Service PLLC
- Levi L Guerrero
- Thomas I Hazelton
All providers in Deckerville, MI · Skilled Nursing Facility in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.