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General NPI Number Information
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NPI Number | 1134759517
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL HOME CARE OF PALM DESERT LLC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 41865 BOARDWALK SUITE 201
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City | PALM DESERT
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State | CA
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Zip | 92211-9026
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Country | US
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Telephone | 760-733-3524
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Fax | 760-773-3526
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Provider Business Mailing Address
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Address Line | 1715 NORTHFIELD DRIVE
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-3819
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Country | US
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Telephone | 248-293-2418
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Fax | 248-293-2401
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. SAM D KASSAB
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Credential |
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Telephone | 248-293-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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