Healthcare Provider Details

I. General information

NPI: 1932206380
Provider Name (Legal Business Name): MAXIM HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 219TH ST SW STE 500
MOUNTLAKE TERRACE WA
98043-2222
US

IV. Provider business mailing address

7227 LEE DEFOREST DRIVE
COLUMBIA MD
21046
US

V. Phone/Fax

Practice location:
  • Phone: 425-245-9940
  • Fax:
Mailing address:
  • Phone: 410-910-1500
  • Fax: 410-910-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIS-373
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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