NPIMap

Organization Active NPI

Guardian Angel Home Care of Bakersfield

  • Home Health Agency
  • Bakersfield, CA
National Provider Identifier
1871138016
Registry record updated Nov 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GUARDIAN ANGEL HOME CARE OF BAKERSFIELD
Practice address
5001 E Commercecenter Dr Ste 240
Bakersfield, CA 93309-1688
Phone
(661) 395-3035
NPI assigned
Nov 12, 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
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

5001 E Commercecenter Dr Ste 240
Bakersfield, CA 93309-1688

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
O20200527000099 CA Part A Provider - Home Health Agency 0042631293 Practice locations: Bakersfield, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871138016. Details of each certification follow.

Home health agency certification: CCN 059724

Legal name
GUARDIAN ANGEL HOME CARE OF BAKERSFIELD
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 17, 2016
Last certification
May 22, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
5001 E Commercecenter Dr
Ste 240
Bakersfield, CA 93309-1688

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angel Home Care of Bakersfield, LLCCCN 059724 · All quality measures
Ownership
Proprietary
Certified
Jun 17, 2016
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

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%
Mary Helen Runnels Individual W-2 Managing EmployeeDon/Clinical Manager Apr 1, 2020
Operational/Managerial ControlDon/Clinical Manager Apr 1, 2020
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 InterestCeo/Director Apr 1, 2020 100%
Corporate OfficerCeo/Director Apr 1, 2020
Corporate DirectorCeo/Director Apr 1, 2020
Operational/Managerial ControlCeo/Director 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

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2020 Change of OwnershipThis provider was the buyer Guardian Angel Home Care IncCCN 059724, CA, NPI 1720475809

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": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573603200000",
    "number": "1871138016",
    "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": "5001 E COMMERCECENTER DR STE 240",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933091688",
            "telephone_number": "661-395-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE OF BAKERSFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "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": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bakersfield, CA

Sources for this page

Verify at the official NPI Registry.