MEDICARE: GUARDIAN ANGEL HOME CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063441871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGEL HOME CARE, INC.

Provider Business Mailing Address
First Line	:	1715 NORTHFIELD DRIVE
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3819
Country	:	US
Telephone Number	:	248-293-2400
Fax Number	:	248-293-2401

Provider Business Practice Location Address
First Line	:	3505 CAMINO DEL RIO S STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4016
Country	:	US
Telephone Number	:	619-640-4383
Fax Number	:	619-640-4385

Authorized Official
Title or Position	:	CEO
Name	:	MR. SAM D. KASSAB
Credential	:
Telephone Number	:	248-293-2400

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	10/06/2015

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