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General NPI Number Information
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NPI Number | 1467678813
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Entity Type | Organization
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Legal Business Name | MAXICARE SELECT, INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 8333 W. MCNAB RD #113
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City | TAMARAC
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State | FL
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Zip | 33321
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Country | US
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Telephone | 954-771-2399
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Fax | 954-771-2491
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Provider Business Mailing Address
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Address Line | 8333 W. MCNAB RD. #113
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City | TAMARAC
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State | FL
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Zip | 33321
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Country | US
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Telephone | 954-771-2399
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Fax | 954-771-2491
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA COOPER
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Credential |
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Telephone | 954-771-2399
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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 | 299991469
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299991555
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License Number State | FL
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