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General NPI Number Information
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NPI Number | 1700962669
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL HOME CARE, INC.
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 3275 ALI BABA LANE, SUITE 506
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City | LAS VEGAS
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State | NV
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Zip | 89118-1774
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Country | US
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Telephone | 702-450-1855
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Fax | 702-450-1854
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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 | 248-293-2400
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Fax | 248-293-2401
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Authorized Official
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Title or Position | CEO
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Name | MR. SAM D. KASSAB
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Credential | CEO/PRESIDENT
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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 | NV
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