NPIMap

Organization Active NPI

Guardian Angel Home Care of San Jose

  • Home Health Agency
  • San Jose, CA
National Provider Identifier
1023653011
Registry record updated Nov 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GUARDIAN ANGEL HOME CARE OF SAN JOSE
Practice address
1885 The Alameda Ste 208
San Jose, CA 95126-1747
Phone
(408) 261-1120
Fax
(408) 260-2413
NPI assigned
Nov 13, 2019
Last updated
Nov 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sam D Kassab
Title
Ceo
Phone
(248) 293-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1885 The Alameda Ste 208
San Jose, CA 95126-1747

Mailing address

1715 Northfield Dr
Rochester Hills, MI 48309-3819
Phone (248) 293-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200527000023 CA Part A Provider - Home Health Agency 9234550476 Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023653011. Details of each certification follow.

Home health agency certification: CCN 059778

Legal name
GUARDIAN ANGEL HOME CARE OF SAN JOSE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 6, 2016
Last certification
Oct 18, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
1885 The Alameda
Ste 208
San Jose, CA 95126-1747

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of San Jose LLCCCN 059778 · All quality measures
Ownership
Proprietary
Certified
Dec 6, 2016
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Guardian Angel Home Care Inc Organization, Rochester Hills, MI Corporation, For-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2020 100%
Gerald Kustra Individual Corporate DirectorBoard Member Apr 1, 2020
Faye Kassab Individual Corporate DirectorBoard Member Apr 1, 2020
Guardian Angel Home Care of Northern California Organization, Rochester Hills, MI LLC, For-profit 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%
Sam D Kassab Individual 5% Or Greater Indirect Ownership InterestCeo/Director Apr 1, 2020 100%
Corporate OfficerCeo/Director Apr 1, 2020 100%
Corporate DirectorCeo/Director Apr 1, 2020 100%
Operational/Managerial ControlCeo/Director Apr 1, 2020 100%
Sandra Gavney Individual W-2 Managing EmployeeClinical Manager Apr 1, 2020
Operational/Managerial ControlClinical Manager Apr 1, 2020
Susan Freilino Individual W-2 Managing EmployeeAdministrator Apr 1, 2020
Operational/Managerial ControlAdministrator Apr 1, 2020

Facilities with the same owner 18

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 18

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2020 Change of OwnershipThis provider was the buyer Guardian Angel Home Care IncCCN 059778, CA, NPI 1285011676

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573603200000",
    "number": "1023653011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 NORTHFIELD DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483093819",
            "telephone_number": "248-293-2400",
            "fax_number": "248-293-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 THE ALAMEDA STE 208",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261747",
            "telephone_number": "408-261-1120",
            "fax_number": "408-260-2413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF SAN JOSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2019-11-13",
        "status": "A",
        "authorized_official_last_name": "KASSAB",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-293-2400"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.