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NPI Code Detail

MEDICARE: GUARDIAN ANGEL OUTPATIENT REHAB INC

MEDICARE: GUARDIAN ANGEL OUTPATIENT REHAB 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
1261QP2000XPhysical Therapy Clinic/CenterMI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1164198OTHERMIGREAT LAKES HEALTH PLAN
230635OTHERMIBCBSM
3025370OTHERMIMIDWEST HEALTH PLAN
41029053OTHERMIMCLAREN HEALTH PLAN

General Provider Information

NPI Number : 1821097684
Entity Type Code : Organization
Provider Name (Legal Business Name) : GUARDIAN ANGEL OUTPATIENT REHAB INC
Provider Business Mailing Address
First Line : 1715 NORTHFIELD DR
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 : 34612 DEQUINDRE RD
Second Line : SUITE C
City : STERLING HTS
State : MI
Zip : 48310-5233
Country : US
Telephone Number : 586-983-4101
Fax Number :
Authorized Official
Title or Position : CEO/OWNER
Name : SAM D. KASSAB
Credential :
Telephone Number : 248-293-2400
Provider Enumeration Date : 07/14/2005
Last Update Date : 01/02/2013

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Directions to “GUARDIAN ANGEL OUTPATIENT REHAB INC ” Practice Location

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