Provider Demographics
NPI:1700416179
Name:GUARDIAN ANGEL HOME CARE OF LAS VEGAS
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE OF LAS VEGAS
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 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:248-293-2418
Mailing Address - Fax:248-293-2401
Practice Address - Street 1:7830 WEST ANN RD
Practice Address - Street 2:STE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-5605
Practice Address - Country:US
Practice Address - Phone:702-450-1855
Practice Address - Fax:702-450-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV170962669Medicaid