Basic Information
| Provider Information | |||||||||
| NPI: | 1447364948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAXIM HEALTHCARE SERVICES, INC, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7227 LEE DEFOREST RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210463236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109101500 | ||||||||
| FaxNumber: | 4109101600 | ||||||||
| Practice Location | |||||||||
| Address1: | 16201 E INDIANA AVE STE 3400 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992162830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093246421 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | KOWALCZYK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4109101500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | IS-374 | WA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 2199737 | 05 | WA | MEDICAID | 807748800 | 05 | ID | MEDICAID | 807748801 | 05 | ID | MEDICAID | 807748802 | 05 | ID | MEDICAID |