Basic Information
| Provider Information | |||||||||
| NPI: | 1841515251 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAXIM HEALTHCARE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5838 EDISON PL STE 120 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920085520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604380078 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5838 EDISON PL STE 120 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920085520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604380078 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2010 | ||||||||
| LastUpdateDate: | 03/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | TWIGGER | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7604380078 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 1990151 | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.