MEDICARE: MAXIM HEALTH SYSTEMS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC8570	OTHER	FL	HEALTH CARE CLINIC LICENSE

General Provider Information

NPI Number	:	1962735357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM HEALTH SYSTEMS LLC

Provider Business Mailing Address
First Line	:	7221 LEE DEFOREST DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 N CONGRESS AVE
Second Line	:	SUITE 330
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-3320
Country	:	US
Telephone Number	:	561-733-3130
Fax Number	:

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

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/21/2009

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Directions to “MAXIM HEALTH SYSTEMS LLC ” Practice Location

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