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	IS-375	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1699872051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTHCARE SERVICES, INC.

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

Provider Business Practice Location Address
First Line	:	950 BROADWAY STE 301
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-4454
Country	:	US
Telephone Number	:	253-671-9909
Fax Number	:	253-671-9979

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/28/2023

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