NPIMap

Organization Active NPI

Guardian Angel Home Care and Hospice of Rochester Hills

  • Community Based Hospice Care Agency
  • Rochester Hills, MI
National Provider Identifier
1306481387
Registry record updated Nov 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
GUARDIAN ANGEL HOME CARE AND HOSPICE OF ROCHESTER HILLS
Practice address
1715 Northfield Dr
Rochester Hills, MI 48309-3819
Phone
(248) 293-2400
Fax
(248) 293-2401
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
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

1715 Northfield Dr
Rochester Hills, MI 48309-3819

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 MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200428000287 MI Part A Provider - Hospice 6800226119 Practice locations: Rochester Hills, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306481387. Details of each certification follow.

Hospice certification: CCN 231615

Legal name
GUARDIAN ANGEL HOME CARE AND HOSPICE OF ROCHESTER HILLS
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 27, 2009
Last certification
Apr 7, 2011
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
1715 Northfield Dr
Rochester Hills, MI 48309-3819

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Guardian Angel Home Care & Hospice of Rochester HillsCCN 231615 · All quality measures
Ownership
For-Profit
Certified
Oct 27, 2009
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Guardian Angel Home Care and Hospice of2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

4201 Saint Antoine St
Ste 2F
Detroit, MI 48201
Phone (313) 578-3235

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
Faye Kassab Individual Corporate DirectorBoard Member Apr 1, 2020
Guardian Angel Home Care of Michigan Organization, Rochester Hills, MI LLC 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/Administrator Apr 1, 2020
Corporate DirectorCeo/Director/Administrator Apr 1, 2020
W-2 Managing EmployeeCeo/Director/Administrator Apr 1, 2020
Operational/Managerial ControlCeo/Director/Administrator Apr 1, 2020
Madeline Boyd Individual W-2 Managing EmployeeClinical Manager Apr 1, 2020
Operational/Managerial ControlClinical 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

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2020 Change of OwnershipThis provider was the buyer Guardian Angel Hospice Care.CCN 231615, MI, NPI 1669626891

Change of ownership 1

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573603200000",
    "number": "1306481387",
    "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": "1715 NORTHFIELD DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483093819",
            "telephone_number": "248-293-2400",
            "fax_number": "248-293-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE AND HOSPICE OF ROCHESTER HILLS",
        "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": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

Verify at the official NPI Registry.