Healthcare Provider Details

I. General information

NPI: 1174435358
Provider Name (Legal Business Name): MAXIM HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16510 ANTELOPE ST
LAKE ELSINORE CA
92530-1769
US

IV. Provider business mailing address

16510 ANTELOPE ST
LAKE ELSINORE CA
92530-1769
US

V. Phone/Fax

Practice location:
  • Phone: 951-409-4989
  • Fax: 907-770-0862
Mailing address:
  • Phone: 951-409-4989
  • Fax: 907-770-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: REBECCA GREEN
Title or Position: BT
Credential:
Phone: 951-409-4989