Healthcare Provider Details

I. General information

NPI: 1891386819
Provider Name (Legal Business Name): MAXIM HEALTHCARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8521 SIX FORKS RD STE 350
RALEIGH NC
27615-5863
US

IV. Provider business mailing address

7227 LEE DEFOREST DR
COLUMBIA MD
21046-3236
US

V. Phone/Fax

Practice location:
  • Phone: 919-676-3118
  • Fax:
Mailing address:
  • Phone: 410-910-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID KOWALCZYK
Title or Position: CONTROLLER
Credential:
Phone: 410-910-1500