NPIMap

Organization Active NPI

Guardian Angel Home Care of Park Ridge

  • Home Health Agency
  • Park Ridge, IL
National Provider Identifier
1093353518
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GUARDIAN ANGEL HOME CARE OF PARK RIDGE
Practice address
1420 Renaissance Dr Ste 215
Park Ridge, IL 60068-1342
Phone
(847) 674-2711
Fax
(847) 795-3441
NPI assigned
Dec 16, 2019
Last updated
Dec 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 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

1420 Renaissance Dr Ste 215
Park Ridge, IL 60068-1342

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 IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200709003787 IL Part A Provider - Home Health Agency 7911320866 Practice locations: Park Ridge, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093353518. Details of each certification follow.

Home health agency certification: CCN 148011

Legal name
GUARDIAN ANGEL HOME CARE OF PARK RIDGE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 17, 2008
Last certification
Mar 21, 2014
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
1420 Renaissance Dr
Ste 215
Park Ridge, IL 60068-1342

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of Park Ridge, IncCCN 148011 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Jul 17, 2008
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 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
Guardian Angel Home Care of Illinois Organization, Rochester Hills, MI LLC 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%
Faye Kassab Individual Corporate DirectorBoard Member Apr 1, 2020
Cherrlyn Cadenas Individual Operational/Managerial ControlAgency Supervisor Apr 1, 2020
Felicia Taylor Individual W-2 Managing EmployeeAdmin Apr 1, 2020
Operational/Managerial ControlAdmin Apr 1, 2020
Sam D Kassab Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2020 100%
Corporate OfficerCeo/Director Apr 1, 2020
Corporate DirectorCeo/Director Apr 1, 2020
Operational/Managerial ControlCeo/Director 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

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1093353518",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 RENAISSANCE DR STE 215",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681342",
            "telephone_number": "847-674-2711",
            "fax_number": "847-795-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF PARK RIDGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "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 Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.