Basic Information
Provider Information
NPI: 1972566701
EntityType: 2
ReplacementNPI:  
OrganizationName: MAXIM HEALTHCARE SERVICES, INC.
LastName:  
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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: 7550 W IH 10 STE 1005
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782295803
CountryCode: US
TelephoneNumber: 2103413800
FaxNumber: 8552187226
Other Information
ProviderEnumerationDate: 04/11/2006
LastUpdateDate: 11/26/2021
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: KOWALCZYK
AuthorizedOfficialFirstName: DAVID
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: REGIONAL VP OF FINANCE
AuthorizedOfficialTelephone: 4109101500
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate: 11/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251J00000X  N AgenciesNursing Care 
251E00000X007943TXY AgenciesHome Health 

ID Information
IDTypeStateIssuerDescription
15967510105TX MEDICAID
00100491905TX MEDICAID


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