Organization
GUARDIAN ANGEL OUTPATIENT REHAB INC
Active
Organization
GUARDIAN ANGEL OUTPATIENT REHAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM D. KASSAB (CEO/OWNER)
(248) 293-2400
Entity
Organization
Contact information
Practice address
34612 DEQUINDRE RD, SUITE C, STERLING HTS, MI 48310-5233
(586) 983-4101
Mailing address
1715 NORTHFIELD DR, ROCHESTER HILLS, MI 48309-3819
(248) 293-2400
(248) 293-2401
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025370
MIDWEST HEALTH PLAN
MI
01
—
1029053
MCLAREN HEALTH PLAN
MI
01
—
164198
GREAT LAKES HEALTH PLAN
MI
01
—
30635
BCBSM
MI
Enumeration date
07/14/2005
Last updated
01/02/2013
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