NPIMap

Organization Active NPI

Guardian Angel Home Care of Grand Rapids

  • Home Health Agency
  • Grandville, MI
National Provider Identifier
1659916633
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GUARDIAN ANGEL HOME CARE OF GRAND RAPIDS
Practice address
2905 Wilson Ave SW Ste 202
Grandville, MI 49418-1287
Phone
(616) 361-3940
Fax
(616) 361-3946
NPI assigned
Nov 13, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

2905 Wilson Ave SW Ste 202
Grandville, MI 49418-1287

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
O20200428000771 MI Part A Provider - Home Health Agency 1254761570 Practice locations: Grandville, MI

Home health agency certification: CCN 237824

Legal name
GUARDIAN ANGEL HOME CARE OF GRAND RAPIDS
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 7, 2008
Last certification
Mar 21, 2014
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
2905 Wilson Ave SW
Ste 202
Grandville, MI 49418-1287

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of Grand RapidsCCN 237824
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
May 7, 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 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%
Tricia J Feenstra Individual W-2 Managing EmployeeAdministrator/Don/Director of CL Apr 1, 2020
Operational/Managerial ControlAdministrator/Don/Director of CL Apr 1, 2020
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 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

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2020 Change of OwnershipThis provider was the buyer Guardian Angel Home Care IncCCN 237824, MI, NPI 1629116769

Change of ownership 1

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

Practitioners & affiliated clinicians

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": "1641427200000",
    "number": "1659916633",
    "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": "2905 WILSON AVE SW STE 202",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181287",
            "telephone_number": "616-361-3940",
            "fax_number": "616-361-3946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF GRAND RAPIDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "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 Grandville, MI

Sources for this page

Verify at the official NPI Registry.