Basic Information
| Provider Information | |||||||||
| NPI: | 1285736520 | ||||||||
| EntityType: | 2 | ||||||||
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| 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 | ||||||||
| FaxNumber: | 4109101600 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 E RIVER DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061084200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602919936 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 09/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | SIPES | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4109101500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 332U00000X | N | Suppliers | Home Delivered Meals | 376J00000X | 0004 | CT | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Homemaker | 251E00000X | 0004 | CT | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 004220943 | 05 | CT | MEDICAID | 0600091 | 05 | MA | MEDICAID | 00422064 | 01 | CT | PERFORMING PROVIDER | OTHER |