MEDICARE: MAXUS HEALTHCARE PARTNERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	15695	TX

General Provider Information

NPI Number	:	1407191612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXUS HEALTHCARE PARTNERS LLC

Provider Business Mailing Address
First Line	:	1021 WASHINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3021
Country	:	US
Telephone Number	:	817-921-6400
Fax Number	:	817-921-6407

Provider Business Practice Location Address
First Line	:	1021 WASHINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3021
Country	:	US
Telephone Number	:	817-921-6400
Fax Number	:	817-921-6407

Authorized Official
Title or Position	:	DIRECTOR OF QM/COMPLIANCE
Name	:	MISS PENNY RIVERA
Credential	:	RN
Telephone Number	:	817-921-6400

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	08/25/2021

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