Basic Information
| Provider Information | |||||||||
| NPI: | 1891059705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAXIM HEALTHCARE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E ESPLANADE DR | ||||||||
| Address2: | SUITE 335 | ||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930362110 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5740 RALSTON ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930036051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052893203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 06/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | MARES | ||||||||
| AuthorizedOfficialFirstName: | DEANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | LVN | ||||||||
| AuthorizedOfficialTelephone: | 8058143559 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.