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General NPI Number Information
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NPI Number | 1275896037
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Entity Type | Organization
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Legal Business Name | MAXIM
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 17908 E AMHERST AVE
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City | AURORA
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State | CO
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Zip | 80013-2122
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Country | US
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Telephone | 720-324-3755
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Fax |
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Provider Business Mailing Address
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Address Line | 17908 E AMHERST AVE
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City | AURORA
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State | CO
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Zip | 80013-2122
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Country | US
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Telephone | 720-324-3755
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH AIDE
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Name | MR. TIMOTHY LAMARR BRENT SR.
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Credential | BA
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Telephone | 720-324-3755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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