Provider Demographics
NPI:1588651798
Name:GUARDIAN ANGEL HOME CARE, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 DRIVE
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:248-293-2401
Practice Address - Street 1:1715 NORTHFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3819
Practice Address - Country:US
Practice Address - Phone:248-293-2400
Practice Address - Fax:248-293-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11144OtherCAPE HEALTH PLAN
MIOE897OtherBLUE CROSS BLUE SHIELD
MI008126OtherMIDWEST HEALTH PLAN
MI31650OtherHEALTH PLAN OF MICHIGAN
MI3339883Medicaid
23-7417Medicare UPIN
MI3339883Medicaid