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General NPI Number Information
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NPI Number | 1821097684
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL OUTPATIENT REHAB INC
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 34612 DEQUINDRE RD SUITE C
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City | STERLING HTS
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State | MI
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Zip | 48310-5233
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Country | US
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Telephone | 586-983-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 NORTHFIELD DR
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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/OWNER
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Name | 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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | MI
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