Healthcare Provider Details

I. General information

NPI: 1669626891
Provider Name (Legal Business Name): GUARDIAN ANGEL HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 NORTHFIELD DRIVE
ROCHESTER HILLS MI
48309-3819
US

IV. Provider business mailing address

1715 NORTHFIELD DRIVE
ROCHESTER HILLS MI
48309-3819
US

V. Phone/Fax

Practice location:
  • Phone: 248-293-2441
  • Fax: 248-293-2401
Mailing address:
  • Phone: 248-293-2400
  • Fax: 248-293-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

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