MEDICARE: GUARDIAN ANGEL HOME CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427207026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGEL HOME CARE INC.

Provider Business Mailing Address
First Line	:	1715 NORTHFIELD DRIVE
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	43093-3819
Country	:	US
Telephone Number	:	248-293-2418
Fax Number	:	248-293-2401

Provider Business Practice Location Address
First Line	:	3055 KETTERING BLVD., SUITE 307
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1949
Country	:	US
Telephone Number	:	937-643-3472
Fax Number	:	937-643-3483

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. SAM D KASSAB
Credential	:
Telephone Number	:	248-293-2400

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	10/04/2016

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