Provider Demographics
NPI:1093353518
Name:GUARDIAN ANGEL HOME CARE OF PARK RIDGE
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE OF PARK RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:KASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-293-2400
Mailing Address - Street 1:1715 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3819
Mailing Address - Country:US
Mailing Address - Phone:248-293-2400
Mailing Address - Fax:
Practice Address - Street 1:1420 RENAISSANCE DR STE 215
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1342
Practice Address - Country:US
Practice Address - Phone:847-674-2711
Practice Address - Fax:847-795-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health