Healthcare Provider Details

I. General information

NPI: 1689855173
Provider Name (Legal Business Name): MAXIMUM SECURITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 W CENTER ST SUITE 212
POCATELLO ID
83204-3236
US

IV. Provider business mailing address

357 W CENTER ST SUITE 212
POCATELLO ID
83204-3236
US

V. Phone/Fax

Practice location:
  • Phone: 208-760-0407
  • Fax: 804-915-9440
Mailing address:
  • Phone: 208-760-0407
  • Fax: 804-915-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER LEAVITT JILL LEAVITT
Title or Position: VICE PRESIDENT
Credential: LSW
Phone: 208-760-0407