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Organization Active NPI

Guardian Angel Home Care of Moraine

  • Home Health Agency
  • Moraine, OH
National Provider Identifier
1609412014
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 MORAINE
Practice address
3055 Kettering Blvd Ste 307
Moraine, OH 45439-1987
Phone
(937) 643-3472
Fax
(937) 643-3483
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

3055 Kettering Blvd Ste 307
Moraine, OH 45439-1987

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
O20200708000775 OH Part A Provider - Home Health Agency 8729401807 Practice locations: Moraine, OH

Home health agency certification: CCN 368308

Legal name
GUARDIAN ANGEL HOME CARE OF MORAINE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 1, 2010
Last certification
Apr 1, 2010
Ownership / control type
Non-Profit
Organization structure
LLCProprietary
Enrollment address
3055 Kettering Blvd
Ste 307
Moraine, OH 45439-1987

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of MoraineCCN 368308
Ownership
Non-Profit
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 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 Mem Apr 1, 2020
Faye Kassab Individual Corporate DirectorBoard Member Apr 1, 2020
Jaclyn Bachik Individual W-2 Managing EmployeeAd;Clinical Manager Feb 20, 2026
Other Feb 20, 2026
Sam D Kassab Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2020 100%
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 19

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

View all 19

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2020 Change of OwnershipThis provider was the buyer Guardian Angel Home Care IncCCN 368308, OH, NPI 1427207026

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": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1609412014",
    "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": "3055 KETTERING BLVD STE 307",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391987",
            "telephone_number": "937-643-3472",
            "fax_number": "937-643-3483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF MORAINE",
        "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 Moraine, OH

Sources for this page

Verify at the official NPI Registry.