Basic Information
| Provider Information | |||||||||
| NPI: | 1376630954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAXIM HEALTHCARE SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7227 LEE DEFOREST DR. | ||||||||
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| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21046 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 287 INDEPENDENCE BLVD. | ||||||||
| Address2: | SUITE 118 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574903009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 09/24/2010 | ||||||||
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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 | 163WC2100X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Continence Care | 3747P1801X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant | 385H00000X | N | Respite Care Facility | Respite Care | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 8700460 | 05 | VA | MEDICAID | 8741832 | 05 | VA | MEDICAID | 8771316 | 05 | VA | MEDICAID | 8750718 | 05 | VA | MEDICAID |