# REGENCY ON THE LAKE-FORT GRATIOT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CIENA HEALTHCARE MANAGEMENT, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356491369
- **Legal business name:** CIENA HEALTHCARE MANAGEMENT, INC
- **Authorized official:** MR. MOHAMMAD ASHRAF QAZI (CEO)
- **Authorized official phone:** (248) 386-0300

## Contact information

- **Practice address:** 5669 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
- **Practice address phone:** (810) 385-7260
- **Mailing address:** 5669 LAKESHORE RD, FORT GRATIOT, MI 48059-2817

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 09/16/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09594 | BCBSM PROVIDER CODE | MI |
| 05 | — | 4988052 | — | MI |