MEDICARE: MAXIM HEALTHCARE SERVICES, INC.

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	HHA4131	AZ

General Provider Information

NPI Number	:	1518085323
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	:	5800 W GLENN DR
Second Line	:	SUITE 255
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2468
Country	:	US
Telephone Number	:	719-542-1777
Fax Number	:	719-542-1666

Authorized Official
Title or Position	:	REGIONAL CONTROLLER
Name	:	MR. CHRISTPHER RATHMANN
Credential	:
Telephone Number	:	410-910-1500

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/20/2009

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