Basic Information
| Provider Information | |||||||||
| NPI: | 1578666079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAXIM HEALTHCARE SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7227 LEE DEFOREST DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109101500 | ||||||||
| FaxNumber: | 4109101600 | ||||||||
| Practice Location | |||||||||
| Address1: | 4450 N PROSPECT RD STE S8 | ||||||||
| Address2: | |||||||||
| City: | PEORIA HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616166578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3095660800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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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: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 1010406 | IL | N | Agencies | Home Health | 251J00000X | Y | Agencies | Nursing Care |
No ID Information.