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General NPI Number Information
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NPI Number | 1942605076
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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 | 10/31/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 1428 PHILLIPS LN SUITE B-2
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2537
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Country | US
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Telephone | 805-544-4002
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Fax | 805-544-4003
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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 |
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Fax |
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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 | 248-293-2404
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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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