Provider Demographics
NPI:1669626891
Name:GUARDIAN ANGEL HOME CARE, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE, INC.
Other - Org Name:GUARDIAN ANGEL HOSPICE CARE
Other - Org Type:Doing Business As
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:248-293-2441
Practice Address - Fax:248-293-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081H0002X
MI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231615Medicare Oscar/Certification
23-1615Medicare UPIN