Healthcare Provider Details

I. General information

NPI: 1366948333
Provider Name (Legal Business Name): MAXIMUM COMMUNITY SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 RUSSELL AVE STE D
GAITHERSBURG MD
20879-3287
US

IV. Provider business mailing address

963 RUSSELL AVE STE D
GAITHERSBURG MD
20879-3287
US

V. Phone/Fax

Practice location:
  • Phone: 301-732-3015
  • Fax: 240-553-0479
Mailing address:
  • Phone: 301-732-3015
  • Fax: 240-553-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: ALPHA KAMARA
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-732-3015