Healthcare Provider Details

I. General information

NPI: 1992149454
Provider Name (Legal Business Name): GUARDIAN ANGEL HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 E MAIN ST STE 101
VENTURA CA
93003-2619
US

IV. Provider business mailing address

1715 NORTHFIELD DRIVE
ROCHESTER HILLS MI
48309-3819
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-4862
  • Fax: 805-644-4980
Mailing address:
  • Phone: 248-293-2400
  • Fax: 248-293-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SAM D KASSAB
Title or Position: CEO/PRESIDENT
Credential:
Phone: 248-293-2400