NPIMap

Organization Active NPI

Guardian Angel Home Care of Ventura

  • Home Health Agency
  • Ventura, CA
National Provider Identifier
1114563616
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GUARDIAN ANGEL HOME CARE OF VENTURA
Practice address
2590 E Main St Ste 101
Ventura, CA 93003-2619
Phone
(805) 644-4862
Fax
(805) 644-4980
NPI assigned
Nov 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 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

2590 E Main St Ste 101
Ventura, CA 93003-2619

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
O20200625003246 CA Part A Provider - Home Health Agency 7517389224 Practice locations: Ventura, CA

Home health agency certification: CCN 059614

Legal name
GUARDIAN ANGEL HOME CARE OF VENTURA
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 29, 2014
Last certification
Mar 13, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
2590 E Main St
Ste 101
Ventura, CA 93003-2619

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of Ventura, LLCCCN 059614 ยท All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jul 29, 2014
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

Locations

2590 E Main St
Ste 101
Ventura, CA 93003
Phone (805) 644-4862

Ownership & related parties

All disclosed owners & managing parties 6

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 Central California Organization, Rochester Hills, MI LLC, For-profit 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%
Faye Kassab Individual Corporate DirectorBoard Member 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
Dana Herron Individual W-2 Managing EmployeeAdministrator/Clinical Manager Apr 1, 2020
Operational/Managerial ControlAdministrator/Clinical Manager 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

NPI Registry JSON

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1114563616",
    "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": "2590 E MAIN ST STE 101",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032619",
            "telephone_number": "805-644-4862",
            "fax_number": "805-644-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF VENTURA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2019-11-20",
        "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 Ventura, CA

Sources for this page

Verify at the official NPI Registry.