Healthcare Provider Details

I. General information

NPI: 1821097684
Provider Name (Legal Business Name): GUARDIAN ANGEL OUTPATIENT REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34612 DEQUINDRE RD SUITE C
STERLING HTS MI
48310-5233
US

IV. Provider business mailing address

1715 NORTHFIELD DR
ROCHESTER HILLS MI
48309-3819
US

V. Phone/Fax

Practice location:
  • Phone: 586-983-4101
  • Fax:
Mailing address:
  • Phone: 248-293-2400
  • Fax: 248-293-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

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