Guardian Angel Home Care, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

GUARDIAN ANGEL HOME CARE, INC.

Practice address

1428 Phillips LN
Suite B-2
San Luis Obispo, CA 93401-2537

Phone

(805) 544-4002

Fax

(805) 544-4003

NPI assigned

Oct 31, 2014

Organization subpart

No

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

Authorized official

Name

Sam D Kassab

Title

Ceo/Owner

Phone

(248) 293-2404

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

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

• Guardian Angel Home Care of San Luis Obispo

  • Home Health Agency
  • San Luis Obispo, CA
  • NPI 1629614029

  Sold to, 2020-04-01

  CMS change of ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414713600000",
    "number": "1942605076",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 PHILLIPS LN",
            "address_2": "SUITE B-2",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012537",
            "telephone_number": "805-544-4002",
            "fax_number": "805-544-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-31",
        "last_updated": "2014-10-31",
        "status": "A",
        "authorized_official_last_name": "KASSAB",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "248-293-2404"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Edward Gross, LCSW
• Kevin Grotte
• Michael Grotte, LPT
• Shiou-Feng Gu
• Guardian Angel Home Care of San Luis Obispo
• Jazmin Guerra Lopez
• Callie Guerra
• Trevor Guerra
• Maria Guevara
• Camilo Guiang, MD

• Home Health Agency in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.