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Organization Active NPI

Guardian Angel Home Care of Columbus

  • Home Health Agency
  • Columbus, OH
National Provider Identifier
1043855034
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 COLUMBUS
Practice address
4889 Sinclair Rd Ste 109
Columbus, OH 43229-5433
Phone
(614) 297-4757
Fax
(614) 781-1497
NPI assigned
Nov 13, 2019
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

4889 Sinclair Rd Ste 109
Columbus, OH 43229-5433

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 OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200526001848 OH Part A Provider - Home Health Agency 8921429143 Practice locations: Columbus, OH

Home health agency certification: CCN 368307

Legal name
GUARDIAN ANGEL HOME CARE OF COLUMBUS
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 1, 2010
Last certification
Jul 8, 2016
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Oct 24, 2019 in OH
Enrollment address
4889 Sinclair Rd
Ste 109
Columbus, OH 43229-5433

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of ColumbusCCN 368307
Overall star rating
2 of 5
Ownership
Proprietary
Certified
Apr 1, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Gerald Kustra Individual Corporate DirectorBoard Member Apr 1, 2020
Faye Kassab Individual Corporate DirectorBoard Member Apr 1, 2020
Jaclyn Bachik Individual W-2 Managing EmployeeAd;Clinical Manager Mar 11, 2026
Sam D Kassab Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2020
Corporate OfficerCeo- Dir Apr 1, 2020
Corporate DirectorCeo -Dir Apr 1, 2020
Operational/Managerial ControlCeo-Dir Apr 1, 2020
Guardian Angel Home Care of Ohio LLC Organization, Rochester Hills, MI LLC 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%

Facilities with the same owner 3

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

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2020 Change of OwnershipThis provider was the buyer Guardian Angel Home Care IncCCN 368307, OH, NPI 1962652529

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": "1043855034",
    "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": "4889 SINCLAIR RD STE 109",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432295433",
            "telephone_number": "614-297-4757",
            "fax_number": "614-781-1497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF COLUMBUS",
        "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 Columbus, OH

Sources for this page

Verify at the official NPI Registry.