NPIMap

Organization Active NPI

Deckerville Nursing Center, LLC

Doing business as Autumnwood of Deckerville

  • Skilled Nursing Facility
  • Deckerville, MI
National Provider Identifier
1669479804
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DECKERVILLE NURSING CENTER, LLC
Doing business as
Autumnwood of Deckerville
Practice address
3387 Ella
Deckerville, MI 48427-9441
Phone
(810) 376-2145
Fax
(810) 376-4093
NPI assigned
Jul 1, 2005
Last updated
Sep 16, 2026By the provider in NPPES
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

3387 Ella
Deckerville, MI 48427-9441

Mailing address

3387 Ella
Deckerville, MI 48427-9441
Phone (810) 376-2145

Other names 1

  • Autumnwood of Deckerville Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030131000023 MI Part A Provider - Skilled Nursing Facility 2163330853 Practice locations: Deckerville, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669479804. Details of each certification follow.

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
LLCProprietary
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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Autumnwood of DeckervilleCCN 235446 · All quality measures
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
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8479.9 residents per day on average
Chain
Ciena Healthcare/Laurel Health Care81 facilities in the chain
Penalties (3 years)
2Fines totaling $61,621

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
23D0886046Autumnwood of Deckerville3387 Ella Street P O Box 1000, Deckerville, MI 48427Certificate of waiverMay 11, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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 Oct 1, 1999
Adp of the SNF Apr 8, 2025
Anis Khan Individual Operational/Managerial Control Oct 1, 1999
Managing Control - Governing BodyManager Oct 1, 1999
Adp of the SNF Oct 1, 1999
Individual Adp of the SNF Mar 1, 2022
Mohammad a. Qazi Individual 5% Or Greater Indirect Ownership InterestManager Oct 1, 1999 100%
Operational/Managerial Control Oct 1, 1999
Managing Control - Governing BodyManager Oct 1, 1999
Adp of the SNF Oct 1, 1999
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 Oct 1, 1999 100%
Adp of the SNF Oct 1, 1999
Nick S Buttar Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Organization, Southfield, MI LLC, For-profit Adp of the SNF Oct 1, 1999
Individual Adp of the SNF Dec 1, 2024
Organization, Glenview, IL LLC, For-profit Adp of the SNF Mar 18, 2025
Individual Adp of the SNF Jan 3, 2003
Organization, Taylor, MI LLC, For-profit Adp of the SNF Mar 18, 2025
Individual Adp of the SNF Jan 17, 2022
Kerry Regentin Individual Operational/Managerial Control Jan 3, 2024
Adp of the SNF Jan 3, 2024

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 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": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789516800000",
    "number": "1669479804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3387 ELLA",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484279441",
            "telephone_number": "810-376-2145",
            "fax_number": "810-376-4093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3387 ELLA",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484279441",
            "telephone_number": "810-376-2145",
            "fax_number": "810-376-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECKERVILLE NURSING CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIENA HEALTHCARE MANAGEMENT, INC",
        "enumeration_date": "2005-07-01",
        "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": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "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",
            "affiliation": "Y",
            "affiliationName": "Ability Network Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Autumnwood of Deckerville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deckerville, MI

Sources for this page

Verify at the official NPI Registry.