Basic Information
| Provider Information | |||||||||
| NPI: | 1912144684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAXIM HEALTHCARE SERVICES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MAXIM HEALTHCARE SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5066 N FRESNO ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937107615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592272250 | ||||||||
| FaxNumber: | 5592271481 | ||||||||
| Practice Location | |||||||||
| Address1: | 5066 N FRESNO ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937107615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592272250 | ||||||||
| FaxNumber: | 5592271481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2009 | ||||||||
| LastUpdateDate: | 05/15/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CANTU | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5592272250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | CA | Y | Agencies | In Home Supportive Care |
No ID Information.