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General NPI Number Information
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NPI Number | 1407191612
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Entity Type | Organization
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Legal Business Name | MAXUS HEALTHCARE PARTNERS LLC
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 1021 WASHINGTON AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3021
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Country | US
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Telephone | 817-921-6400
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Fax | 817-921-6407
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Provider Business Mailing Address
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Address Line | 1021 WASHINGTON AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-3021
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Country | US
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Telephone | 817-921-6400
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Fax | 817-921-6407
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Authorized Official
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Title or Position | DIRECTOR OF QM/COMPLIANCE
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Name | MISS PENNY RIVERA
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Credential | RN
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Telephone | 817-921-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 15695
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License Number State | TX
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