Healthcare Provider Details

I. General information

NPI: 1700416179
Provider Name (Legal Business Name): GUARDIAN ANGEL HOME CARE OF LAS VEGAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 11/29/2024
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N. DURANGO DRIVE SUITE 150
LAS VEGAS NV
89145-5604
US

IV. Provider business mailing address

1715 NORTHFIELD DR.
ROCHESTER HILLS MI
48309-3819
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-1855
  • Fax: 702-450-1854
Mailing address:
  • Phone: 248-293-2418
  • 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: PRESIDENT/CEO
Credential:
Phone: 248-293-2400