Healthcare Provider Details

I. General information

NPI: 1639272768
Provider Name (Legal Business Name): MAXIM HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 EXECUTIVE DR STE 1
FAIRVIEW HEIGHTS IL
62208-1357
US

IV. Provider business mailing address

11 EXECUTIVE DR STE 1
FAIRVIEW HEIGHTS IL
62208-1357
US

V. Phone/Fax

Practice location:
  • Phone: 618-628-7551
  • Fax:
Mailing address:
  • Phone: 618-628-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010213
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DAVID KOWALCZYK
Title or Position: VP OF FINANCE
Credential:
Phone: 410-910-1500