NPIMap

Organization Active NPI

Northern Oak Management Company, LLC

  • Skilled Nursing Facility
  • Waterford, MI
National Provider Identifier
1811290281
Registry record updated Jun 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
NORTHERN OAK MANAGEMENT COMPANY, LLC
Practice address
1901 N Telegraph Rd
Waterford, MI 48328-1878
Phone
(248) 386-0300
NPI assigned
Dec 7, 2010
Organization subpart
Yes
Parent organization
CIENA HEALTHCARE MANAGEMENT, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2012

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

Authorized official

Name
Mohamed A Qazi
Title
Ceo/President
Phone
(248) 386-0300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1901 N Telegraph Rd
Waterford, MI 48328-1878

Mailing address

1901 N Telegraph Rd
Waterford, MI 48328-1878

Other identifiers 2

IdentifierTypeStateIssuer
2316091MedicaidMI
S9672OtherBCBSM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110523000818 MI Part A Provider - Skilled Nursing Facility 2668658899 Practice locations: Waterford, MI

Skilled nursing facility certification: CCN 235260

Legal name
NORTHERN OAK MANAGEMENT COMPANY LLC
Doing business as
REGENCY AT WATERFORD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1976
Last certification
May 22, 2025
Beds
150
Ownership / control type
Corporation
Multi-facility organization
Cienda Health Care Management
Most recent change of ownership
Jun 20, 2011
Organization structure
LLCProprietary
Enrollment address
1901 N Telegraph Rd
Waterford, MI 48328-1878
Nursing home name
REGENCY AT WATERFORD
Affiliated entity
CIENA HEALTHCARE/LAUREL HEALTH CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Regency at WaterfordCCN 235260
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 1, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
150124.9 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
23D2024345Regency at Waterford1901 N Telegraph, Waterford, MI 48328Certificate of waiverMay 12, 2027

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 Jun 1, 2011
Adp of the SNF Mar 20, 2025
Anis Khan Individual Operational/Managerial Control Jun 1, 2011
Managing Control - Governing BodyManager Jun 1, 2011
Adp of the SNF Jun 1, 2011
Organization, Glenview, IL LLC, For-profit Adp of the SNF Mar 20, 2025
Individual Adp of the SNF Dec 1, 2024
Mohammad a. Qazi Individual 5% Or Greater Indirect Ownership InterestManager Jun 1, 2011 100%
Operational/Managerial Control Jun 1, 2011
Managing Control - Governing BodyManager Jun 1, 2011
Adp of the SNF Jun 1, 2011
Organization, Taylor, MI LLC, For-profit Adp of the SNF Mar 20, 2025
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 Direct Ownership Interest Jun 1, 2011 100%
Adp of the SNF Jun 1, 2011
Individual Adp of the SNF Jun 1, 2011
Scott Avery Individual Operational/Managerial Control Nov 16, 2022
Adp of the SNF Nov 16, 2022
Individual Adp of the SNF Jan 17, 2022
Individual Adp of the SNF Mar 1, 2022
Organization, Southfield, MI LLC, For-profit Adp of the SNF Jun 1, 2011
Anna Gardina Individual Adp of the SNF Jan 23, 2025
Purvaj Mahendra Patel Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025

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.

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": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340841600000",
    "number": "1811290281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 N TELEGRAPH RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 N TELEGRAPH RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281878",
            "telephone_number": "248-386-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN OAK MANAGEMENT COMPANY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CIENA HEALTHCARE MANAGEMENT, INC",
        "enumeration_date": "2010-12-07",
        "last_updated": "2012-06-28",
        "status": "A",
        "authorized_official_last_name": "QAZI",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "248-386-0300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2316091",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "S9672",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

Verify at the official NPI Registry.