Basic Information
| Provider Information | |||||||||
| NPI: | 1003918483 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAXIM HEALTHCARE SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7227 LEE DEFOREST DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210463236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109101500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2473 CARE DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323089814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504221111 | ||||||||
| FaxNumber: | 8504221101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | BRICKHOUSE | ||||||||
| AuthorizedOfficialFirstName: | DUANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4109101500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 29999178 | FL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 651025600 | 05 | FL | MEDICAID | 001137200 | 05 | FL | MEDICAID | 687128300 | 05 | FL | MEDICAID | 687715079 | 05 | FL | MEDICAID | 687323500 | 05 | FL | MEDICAID |