NPIMap

Organization Active NPI

Guardian Angel Home Care of Santa Rosa

  • Home Health Agency
  • Santa Rosa, CA
National Provider Identifier
1194361592
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GUARDIAN ANGEL HOME CARE OF SANTA ROSA
Practice address
100 Stony Point Suite 265
Santa Rosa, CA 95401-5415
Phone
(707) 526-5210
Fax
(707) 526-5211
NPI assigned
Nov 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

100 Stony Point Suite 265
Santa Rosa, CA 95401-5415

Mailing address

1715 Northfield Dr
Rochester Hills, MI 48309-3819
Phone (248) 293-2418

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200616002697 CA Part A Provider - Home Health Agency 5799107983 Practice locations: Santa Rosa, CA

Home health agency certification: CCN 053101

Legal name
GUARDIAN ANGEL HOME CARE OF SANTA ROSA
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 20, 2017
Last certification
Feb 21, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
100 Stony Point Rd
Ste 265
Santa Rosa, CA 95401-4155

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of Santa Rosa, LLCCCN 053101
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Apr 20, 2017
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
Tax ID family
Guardian Angel Hospice Care7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 Stony Point Rd
Ste 265
Santa Rosa, CA 95401
Phone (707) 526-5210

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 Interest Apr 1, 2020 100%
Corporate OfficerCeo/Director Apr 1, 2020
Corporate DirectorCeo/Director Apr 1, 2020
Operational/Managerial ControlCeo/Director Apr 1, 2020
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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1194361592",
    "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": "248-293-2418",
            "fax_number": "248-293-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STONY POINT SUITE 265",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015415",
            "telephone_number": "707-526-5210",
            "fax_number": "707-526-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF SANTA ROSA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "KASSAB",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/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 Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.