Provider Demographics
NPI:1659916633
Name:GUARDIAN ANGEL HOME CARE OF GRAND RAPIDS
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE OF GRAND RAPIDS
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:248-293-2401
Practice Address - Street 1:2905 WILSON AVE SW STE 202
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1287
Practice Address - Country:US
Practice Address - Phone:616-361-3940
Practice Address - Fax:616-361-3946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health