MEDICARE: MAXIM HEALTHCARE SERVICES, INC,

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency	IS-374	WA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1447364948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTHCARE SERVICES, INC,

Provider Business Mailing Address
First Line	:	7227 LEE DEFOREST RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3236
Country	:	US
Telephone Number	:	410-910-1500
Fax Number	:	410-910-1600

Provider Business Practice Location Address
First Line	:	16201 E INDIANA AVE STE 3400
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2830
Country	:	US
Telephone Number	:	509-324-6421
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	DAVID KOWALCZYK
Credential	:
Telephone Number	:	410-910-1500

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	09/18/2024

200 COTTAGE AVE , STE 101
MANTECA, CA
95336-4935

Practice Phone: 209-239-2197
Practice Fax: 209-239-7672